TPM SEPTEMBER 2013

THE BEST JOB IN THE WORLDwww.thepractisingmidwife.com Volume 16 no 8 • September 2013Education Using simulation in comPlsuptuhslepeFmprRalEeepEnmieteasnryt midwifery education The role of mentors in the evaluation of learning Narrative pedagogy A new approach to reflection

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Contents4 EDITORIAL 26 Maintaining the passion for pinards Hannah Smith explains why the ability to use a pinard is5 COMMENT Click all about it! Dr Julie Wray important for mother, baby and midwife6 Sponsored elective placement to Uganda 30 Time to reflect Following on from her students’ reflection on their learning, Stevie Walsh assesses8 NEWS the value of using image-rich timelines to enhance the learning experience12 Narrative pedagogy in midwifery education A pioneer of narrative pedagogy, Andrea Gilkison 33 What does midwifery mean to me? The winning explains that this approach to the teaching of entry for the StudentMidwife.NET elective midwifery can have a significant impact on the placement to Tanzania. Helen Braid explains what art of practice midwifery means to her15 The role of the mentor in evaluating learning 35 REVIEWS Claire Bunyan and Louise Lawson describe the role of the mentor in the process of evaluation 36 COCHRANE CORNER Umbilical cord antiseptics for preventing sepsis and death among20 BSI not CSI: birth scene investigation - a newborns Valerie Smith continues the series community midwifery simulation With her second year students having had a successful 39 PROFESSIONAL DEVELOPMENT learning experience, Joy James explains where simulation can go from here 42 LAST WORD Poetic licence Laura Griffin expresses her feelings, about being a student and becoming23 Charting the history of midwifery education a midwife, in poetry Gina Finnerty, Anna Bosanquet and Dawn Aubrey look back at the history of midwifery education, emphasising the value of High Coombe, a teacher training college for midwivesEditorial advisory board © 2013 Medical Education Solutions Ltd. All rights reserved.Susan Crowther RM, BSc (Hons), Joy James RGN, RM, ADM, Cert This journal and the individual contributions contained in it are protected underMSc Midwifery Lecturer, AUT Counselling, Dip Counselling, copyright by Medical Education Solutions Ltd, and the following terms andUniversity, Auckland, New PGCEM, RN, BA, MA Senior conditions apply to their use:Zealand Lecturer, Midwifery, University ofDéirdre Daly MSc, PGDipEd, Glamorgan Photocopying Single photocopies of single articles may be made for personal useBSc (Hons,) RM, DipMid, RGN Anne Marie Rennie MSc, RM, as allowed by national copyright laws. Permission of the Publisher and paymentLecturer in Midwifery, Trinity RGN, ADM, BSc (Hons) of a fee is required for all other photocopying, including multiple or systematicCollege, Dublin Midwifery, PG Cert HELT Lecturer copying, copying for advertising or promotional purposes, resale, and all formsJenny Fraser MSc, RN, RM, DPSM in Midwifery, The Robert Gordon of document delivery. Special rates are available for educational institutions thatIndependent Midwifery University wish to make photocopies for non-profit educational classroom use. 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Back to school Julie Wray and Helen Baston, Joint EditorsThis issue is a real treat. It captures that eagerness for learning, the anticipation of newknowledge and fresh ideas that brim over at the beginning of a new academic year. As new Cover photo:students prepare for the first introduction to their chosen career and returning students reflect James King-Holmes/on how far they have travelled in such a short time, we are reminded of the pressure they face. Science Photo Library Students have met with extremely tough competition for their precious place on amidwifery programme. Academics and maternity service users have had the onerousresponsibility of assessing their potential to become midwives of the future, using a range ofstrategies. The friends and family test (NHS England 2013) is one approach that can be usefulwhen considering whether we would want our relatives to be cared for by the candidate infront of us. Another tool is to consider how the candidate would match up against the 6 Csreflecting compassion in practice (Department of Health (DH) 2012). This September issue has something for every practising midwife. There are articles foracademics, such as the paper by Andrea Gilikson outlining the application of narrativepedagogy and Joy James describing the innovative use of a ‘scenes of crime house’ to simulatea community midwifery scenario. Hannah Smith reminds us of the basics with her passionateaccount of the need for midwives to continue to use pinards. We are also pleased to present our supplement focusing on complementary therapies andthese include: baby massage, hypnobirthing, homeopathy, acupuncture and reflex zonetherapy. So we hope that you feel energised by the summer sun and enjoy a refreshing read of thisbumper issue!ReferencesNHS England (2013). Friends and Family test: www.nhs.uk/friendsandfamily.DH (2012). Compassion in practice, Leeds: Crown. Available at http://tinyurl.com/c5lc4n2CONTACT: 020 8313 9617 SUBSCRIPTIONS: 01752 [email protected]: 66 Siward Road, Bromley BR2 9JZ All subscription enquiries or back issue orders should be addressed to: TPM Subscriptions Department, Proact Marketing, 12 Mary Seacole Road,Joint Editors The Millfields, Plymouth PL1 3JY. Tel: 01752 312140; fax: 01752 313162;Helen Baston PhD, RN, BA (Hons), RM, ADM, MMedSci, PGDipEd email: [email protected] Midwife: Public Health/ Supervisor of Midwives, SheffieldTeaching Hospitals NHS Foundation Trust [email protected] Personal subscription rates (5% direct debit discount in brackets): UK £60Julie Wray PhD, ONC, RN, RM, ADM, MSc, PGCE (HE) (£57); First year of qualification £50 (£47.50); Student (10% direct debitSenior Lecturer, School of Nursing, Midwifery and Social Work, discount) £36 (£32.40); Europe/Eire £70; rest of world £95 (surface) orUniversity of Salford [email protected] £120 (airmail). Institutional/library rates: UK £134; Europe/Eire (airmail) £160; rest of world (air mail) £190. Payment can be made by chequeManaging Editor: Laura Yeates [email protected] payable to ‘The Practising Midwife’ or by credit/debit card: Mastercard,(editorial/author submissions) Visa, American Express and Switch. TPM is published 11 times a year.News Editor: Francesca Robinson [email protected], Copyright: © Medical Education Solutions Ltd, 2013. All rights reserved. No01962 862972 part of ‘The Practising Midwife’ may be reproduced in any material form (including photocopying or storing in any medium by electronic meansAdvertising Manager: Margaret Floate and whether or not transiently or incidentally to some other use of [email protected], 01483 824094 publication) without the written permission of the copyright holder except in accordance with the provisions of the Copyright, Designs andPublisher: Ian Heslop [email protected] Patents Act 1988, or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1P Facebook is a registered 0LP. Applications for the copyright holder’s written permission to trademark of Facebook, Inc. reproduce any part of this publication should be addressed to the publishers. We are now on Twitter - follow us at @ThePractMidwife Printed in Great Britain by Williams Press, Maidenhead ISSN 1461-3123 Disclaimer: The sentiments expressed by the contributors and advertisers in The Practising Midwife do not necessarily reflect the views of either the Editors or the Editorial Advisory Board.Subscribe today – 01752 312140

THE PRACTISING MIDWIFE • September 2013 5 Julie Wray What matters is our relationship with women: Comment our integrity, professionalism, ethical andClick all about it! moral codes, our knowledge base, competencies,Midwifery in the media accountability, our respect,It feels as if childbirth and midwifery have been in the news passion for childbirth andconstantly of late, with the Francis report, Royal birth, Kirstie humanismAllsopp’s views on the pressures on mothers to breast feedand on normal birth, midwifery shortages and the rising birth may have noticed a change of focus to include a more in-rate, to mention but a few. On the one hand this kind of depth analysis of issues of current concern to midwives; theseexposure can be good for women and midwives, as it profiles items encourage discussion about practice with colleagues andthe importance and raises awareness of midwifery care. We indeed the women they care for.all know that when things are working well all is fine. Tweet! Yet on the other hand we need to be cautious of the media, With the digital and social media revolution giving us rapidin that their attitude to childbirth is often polarised away access to information and news with such speed and ease, itfrom the ethos and essence of midwifery. Behind every media is hard to know what is reliable, trustworthy and relevant.story lies a motive that can be one sided, unbalanced and With twitter, news and information are literally at our fingersensational. Too often we get sound bites, half stories and tips. This month TPM could no longer resist and embarked onversions of events that later change, become even more the steep learning curve necesary to join twitter; already wesensational - or disappear. are being followed by approaching 200 tweeters. In joining, we have connected with so many people interested inDifferent perspectives childbirth and midwifery, from doulas to mums, students toAs midwives we know about versions of stories, as often our midwives to celebrities: a whole range of people.accounts of caring for women can be different from howwomen experience or recount events - or indeed how Our newssomeone else might view them. That said, we respect Our readers are individuals and have different preferences fordifferences of opinion and interpretations and are modes of engaging with current affairs and social media sitesaccustomed to handling variance; it’s part of being with are not for everyone. In addition to news analysis, wewomen and of being a midwife. What matters is our currently offer a selection of news highlights within therelationship with women: our integrity, professionalism, journal, for the many who prefer a visual format – both inethical and moral codes, our knowledge base, competencies, print and online. How we learn about and are influenced byaccountability, our respect, passion for childbirth and midwifery in the media is important to us all. Being able tohumanism. All of which guide our practice and conduct, showcase as well as defend and support midwifery positivelyalongside the Nursing and Midwifery Council (NMC), we seek in the media, especially in the current NHS climate, is a realto protect the public and are monitored to ensure that we do. challenge. We all need to be mindful of the headlines andWe would have it no other way, I am sure. take care with the media. TPMRelying on expertise I Do let us know what you think. And do follow us onSo what guides the media? How do we engage with media Twitter @ThePractMidwifedebates? How do we put right incorrect portrayals? I guessone way is to rely on our leaders, the ones in the ‘know’ or Julie Wray is joint editor of The Practising Midwife and seniorlobbyists - or indeed journals, like TPM. lecturer in the school of nursing, midwifery and social work at the University of Salford One of the strengths of TPM journal has for many yearsbeen the news pages, which have aimed to provide excellentupdates on current matters, guiding readers to the originalsources so that they can learn more. In recent months you

Uganda placements Now that she and fellow students have been to Uganda, Rebecca Howard reflects on their experience and the differences between Uganda and the UKA fter so much planning, fundraising and Antenatal ward determination we were finally in Uganda, a place I didn’t expect to be so green, tropical The next day we were better prepared and eager to and lush. As we travelled through the hustleand bustle of each city to the dirt tracks in tiny villages, we experience everything the wards had to offer. Shortly aftergrew excited thinking about what we were about toexperience. However, once our malaria nets were up, after we arrived, Betty the midwifery lecturer came to meet us andtwo days crammed full of a journey of over 4000 miles, wewere ready for a good night’s sleep! guided us around the antenatal ward, acting as a translator,Arrival allowing us to spend time communicating with the women.We had been told by Jeremy Jolley (the internationalcoordinator for the faculty of health and social care at Hull This was such an enlightening experience because we cameUniversity) about the `laid back` Ugandan lifestyle, but itwasn’t until we began working that we truly realised how to realise how the antenatal procedures, terminology, carerelaxed they were. On our introductory day, Jaki, Cara,Sadie and I arrived at Mbarara hospital promptly at 7:30am plans and pathways differed in relation to midwifery practiceas we had been told; however the introductions began justafter 9am. The whole Ugandan culture is very stress-free in the UK. One woman was 29 weeks pregnant with a fetuswhich would later make me think about life at home andwonder whether, perhaps, they had the right idea. that had multiple abnormalities, making it incompatible withFirst day life. Due to the fetalOur first day on the maternity wards hit us all like a tonneof bricks: all the different sights, smells and sounds were abnormalities, a normaloverwhelming on the busy wards; it was definitely adifferent take on maternity care. I began feeling unwell vaginal birth would not beand needed to leave after several hours, as did the others,which we realised was due to the side effects of the anti- possible, so the woman hadmalarial tablets. been patiently waiting for a caesarean section (CS) - but to no avail. Her family had travelled to Mbarara regional referral hospital with her and remained outside the ward, providing her with food and clean clothing. Due to lack of resources, the hospital staff could not facilitate feticide, so the baby`s condition at birth and thereafter would determine its fate. The mother was fully aware of Coffins are for sale just outside th this. of maternal and perinatal mortal

The Practising Midwife is sponsoring four studentmidwives from Hull University to undertake anelective placement in Uganda. We continuefollowing their progress on these pages.Pre-eclampsia but that it was not uncommon for the midwives to workAnother woman was 36 weeks pregnant with severe pre- six or seven days a week, if needed.eclampsia and refusing a CS until her husband arrived tomake the decision. Although she had been waiting over a HIVweek for him to arrive, she could not be persuaded to make There were many posters with flow charts detailing thethe decision without him, despite understanding the risks care pathway and treatment for women and their babies,of continuing the pregnancy. For the next few days we based on mothers’ HIV status. Where a mother was HIVwere encouraged to explore the hospital including the HIV positive, the baby would be treated with Nevirapine daily,clinic; on our return to the maternity ward, I noticed an being tested for HIV at approximately 18 months of age. Inempty bed where the pre-eclamptic woman had been Uganda as a whole, those with HIV have a higher viral loadresting. With no sign of her on the postnatal ward, the (greater susceptibility), compared with those in the UKmatron informed us that she and the baby had died (UNAIDS 2013). Therefore the risk of transmission isfollowing an eclamptic seizure the day after we had seen greater for babies being exclusively breastfed up to sixher. Her husband had still not arrived. months of age. However, whilst we were working on the postnatal ward, no bottle feeding was observed; onlyPostnatal ward breastfeeding. This wasn’t surprising when you consider that it was not uncommon for there to be no runningOn the very cramped 36 bed postnatal ward there were, at water, no form of sterilising equipment and formula milk was extortionately priced.one point, 86 women occupying the beds, some having to Positiveshare mattresses on the floor. Angelica, a student midwife, Each of us agreed on our journey home how insightful the trip had been because, not only had it deepened our reported that this number appreciation of the NHS and the honoured profession that we shall soon be entering, but we have learnt to see the of women, though positive aspects of a situation when, at times, it may appear that all hope is lost. Also we have had the shocking to us, was very opportunity to encounter and experience a side of midwifery that has the potential to enrich our professional common for them. development as midwives. TPM Furthermore, they do not Rebecca Howard is a third year student midwife at Hull University have separate rooms for References the women whose babies UNAIDS (2013). ‘Delivering results toward ending AIDS, tuberculosis and have died so, as awful as it Malaria in Africa: Africa Union accountability report on Africa - G8 partnership commitments, Africa: African Union Commission, NEPAD is, they have to remain on Agency and UNAIDS. the ward seeing other mothers caring for their babies. When discussing working hours with Alice the matron (who, we discovered, was Betty`s sister), she told us that theyhe hospital: a grim reflection of the reality changed frequentlylity between days and nights

News analysis8 • September 2013Staffing levels are key to safecare, finds patient safety reviewA GOVERNMENT REVIEW of patient Recommendations include: reckless neglect or mistreatment ofsafety has recommended that maternity patients should be punished.and other NHS services should be • the NHS needs to adopt a culture ofadequately staffed. learning. This cannot come from “As I travel around, I see many services regulation, but from “countless, already putting the spirit of these The commitment has been welcomed consistent and repeated” messages recommendations into practice and, as aby the Royal College of Midwives (RCM) to staff so that goals and incentives result, offering the highest levels of care.which has, for many years, voiced are clear and in patients’ best Now our task is to ensure these areconcerns about staffing levels in interests; acknowledged and implemented acrossmaternity units. all services.” • connecting with patients: the The review by Professor Don Berwick, frontline leaders need first-hand Catherine Foot, Assistant Director offormer health advisor to President knowledge of the reality of the Policy at The King’s Fund, described theObama and an international patient system and the patient voice must be report as “strong and insightful” but shesafety expert, was commissioned by the heard and heeded at all times; said many of the principles andPrime Minister following publication of recommendations were not new.the Francis Report into the breakdown of • the complaints systems need to becare at Mid Staffordshire Hospitals. continuously reviewed and improved; “The question remains how to make a patient-centred culture that takes safety Professor Berwick says that staffing • transparency must be complete, seriously, a reality.levels should be adequate and based on timely and unequivocal;evidence and should not be dictated “National bodies can help create thefrom the centre. He recommends that • supervisory and regulatory systems right environment for improvement, andNHS boards and local leaders should should be clear - an in-depth, effective regulation is an importanttake responsibility for ensuring that independent review of the structures backstop against failure. However, theclinical areas are adequately staffed. and the regulatory system should be kinds of change that will make the NHS completed by the end of 2017; the safest and most effective health care RCM chief executive Cathy Warwick system in the world, as Don Berwicksaid: “We have a method of calculating • new criminal offences should be believes we can achieve, happen withinstaffing levels in midwifery and we created around recklessness or wilful teams and organisations and takewould encourage NHS organisations to neglect or mistreatment by commitment on the ground over manyuse it and ensure it is followed.” organisations or individuals and for years.” healthcare organisations which Royal College of Nursing Chief withhold or obstruct relevant Professor Don Berwick said: “I am aExecutive and General Secretary, Dr Peter information. But the report great admirer of the NHS – it has been,Carter, also welcomed the emphasises that the use of criminal and still is, very respected around therecommendation. He said: “The growing sanctions should be extremely rare world. This report is one of a number ofbody of evidence shows that the only and unintended errors must not be recent reports that, taken together,way to ensure patient safety is to have criminalised. provide the NHS with a real opportunityadequate staff with the right skills and to deliver the safest healthcare in thethe opportunity to learn and develop on Professor Warwick said it was crucial world.”an ongoing basis.” that midwives and other NHS staff should be free to raise concerns if they Secretary of State for Health, Jeremy Four key findings of the review are: feel safety is being compromised and Hunt, said: “For too long, patient safetythat the quality of patient care, that they should be able to do this and compassionate care have beenespecially patient safety, should be without fear of reprisal. Their concerns secondary concerns in parts of the NHSparamount; patients and carers must be should be listened to and acted upon and this has to change.”empowered, engaged and heard; staff quickly and efficiently.should be supported to develop I A promise to learn, a commitmentthemselves and improve what they do; “I agree that genuine mistakes must to act - Improving the Safety of Patientsand there should be complete not be punished but used to learn from in England can be downloaded at:transparency of data to improve care. and improve care and safety. We would http://tinyurl.com/kfhboa7 agree that the very few cases of wilful or

News analysis September 2013 • 9NICE sets the standard for high quality postnatal careNEW STANDARDS OF POSTNATAL care signs of conditions that may important that there are standards inwhich benchmark the support women threaten their lives and require them place that outline clear, sensible ways toshould receive in the crucial six to eight to access emergency treatment; support and care for women during thisweeks after birth, have been set out by hugely significant time in their lives. Ithe National Institute for Health and • women or main carers of babies are am sure this new quality standardCare Excellence (NICE). advised, within 24 hours of the birth, issued by NICE will be welcomed by of the symptoms and signs of both parents and healthcare The Postnatal quality standard says potentially life threatening professionals alike.”that for the majority of women, babies conditions in the baby that requireand families, the postnatal period ends emergency treatment; Dr Debra Bick, Professor of Evidencesix-eight weeks after the birth. However based midwifery practice, King's Collegefor some women and babies, it should • safer infant sleeping is discussed London and chair of the group whichbe extended in order to meet their needs. with women, their partners or the developed the quality standard, said: main carers at each postnatal “For too long, postnatal care has been This is particularly important where a contact; an invisible part of maternity care, yetwoman or baby has developed evidence shows us the importance ofcomplications and remains vulnerable • women receive breastfeeding planned, high quality support for theto adverse outcomes. For example, this support from a service that uses an shorter- and longer-term health ofcould include women who have poor evaluated, structured programme; women and their babies. This NICEsupport networks, have developed a quality standard will enable healthcarepostnatal infection or other health • information about bottle feeding is professionals to plan and promote careproblem that is continuing to impact on discussed with women or main for women, babies and their families,their daily lives, or women who are at carers of formula-fed babies; which will bring real, tangible benefitsrisk of mental health problems or infant to all.”attachment problems. • babies have a complete six-eight week physical examination. Jane Munro, quality and audit Research over several years by Dr Julie development advisor at the RoyalWray, joint editor of The Practising • women with a body mass index College of Midwives, said: “TheMidwife, senior lecturer and academic (BMI) of 30 kg/m2 or more at the six- publication of this quality standardlead in the School of Nursing, Midwifery eight week postnatal check are gives commissioners and providers ofand Social Work at the University of offered a referral for advice on services important benchmarks toSalford and a member of the NICE panel healthy eating and physical activity; measure their performance against, andwhich produced the standard, confirms sets out the levels of care womenthese concerns about postnatal care. • women have their emotional should expect. We particularly welcomeMany new mothers she has surveyed wellbeing, including their emotional the statements recognising thesay it takes them longer than six to attachment to their baby, assessed importance of emotional well-beingeight weeks to recover fully from giving at each postnatal contact; and maternal mental health - as care inbirth. She has called for more realistic this area has often been under-and woman-friendly postnatal services • women who have transient resourced.to support them. psychological symptoms (‘baby blues’) that have not resolved at 10– “We know that many midwives “For too long postnatal care has been 14 days after the birth should be sometimes struggle to deliver highthe 'Cinderella' of maternity care. These assessed for mental health quality postnatal care because ofstandards are timely and evidence- problems; midwife shortages and lack ofbased with huge scope to improve resources. The challenge for providerspostnatal care and the support that new • a parent or main carer who has will be to ensure midwives have themothers deserve after birth,\" she said. infant attachment problems should time to deliver the high quality care receive services designed to improve these standards are aiming for.” The standard recommends: their relationship with their baby. I The NICE quality standard on• the woman and baby's Professor Gillian Leng, NICE Deputy postnatal care can be downloaded at: individualised postnatal care plan is Chief Executive and Director of Health http://guidance.nice.org.uk/QS37 reviewed and documented at each and Social Care, said: “The period postnatal contact; immediately following the birth of a new baby is an exciting, life-changing• women are advised, within 24 hours time, both for the mother, her partner of the birth, of the symptoms and and their family. However, such great changes can sometimes feel overwhelming for the mother, so it is

News highlights10 • September 2013Midwives are doing too services and midwives were breastfeeding prevalence and Embryology Authority (HFEA)much unpaid overtime struggling to provide high the rates of admission for and the Human Tissue quality antenatal care. children aged from one to Authority (HTA) - willMORE THAN ONE in eight (82 five years. continue as separate bodies,per cent) midwives work References: ONS (2013). Annual the Government hasadditional unpaid hours and References: DH (2013). Infant announced, following anearly half (47 per cent) have mid-year population estimates, review.been unwell due to stress in feeding profiles 2010-2011,the last 12 months, reveals 2011 and 2012, London: ONS. The Department of Healthan analysis by the Royal London: DH. had considered transferringCollege of Midwives (RCM) of www.ons.gov.uk/ons/dcp17177 the functions of the HFEAthe 2012 NHS staff survey. Midwives must be alert and the HTA as part of the 8_320900.pdf for signs of domestic Government’s commitment Also nearly three quarters violence to cut the number of arm’s(71 per cent) of midwives felt Breastfed babies are length bodies. But a reviewthere were not enough staff less likely to be MIDWIVES SHOULD receive has concluded that theyat their organisation for admitted to hospital training so that they can deliver effective regulationthem to do their job properly, recognise the signs of and achieve high levels ofcompared with 48 per cent of HIGHER BREASTFEEDING domestic violence and abuse public and professionalall NHS staff. rates are linked to lower and ensure that those confidence. rates of inpatient admissions affected are aware of the RCM Chief Executive for babies of less than one help and support available to Midwives work withCathy Warwick said: “These year old, reveals the latest them, says new draft physiotherapists toresults are deeply set of infant feeding profiles guidance on identifying and prevent incontinencedisappointing and it’s from the Department of preventing domesticworrying that so many Health (DH) (2013). violence. A POSITION STATEMENTmidwives are working setting out proposals forconsiderable additional These data show that Around 1.2 million reducing incontinenceunpaid hours. We need to babies who were breastfed women and 784,000 men amongst women followinghave enough staff so that were less likely to be aged 16-59 in England and pregnancy and birth hasmidwives can get breaks and admitted to hospital for 10 Wales experienced domestic been drawn up jointly by thefeel valued and appreciated.” conditions, including lower abuse in 2010/11. Almost Royal College of Midwives respiratory tract infections, one third of women and 17 and the Chartered Society ofBaby boom is gastroenteritis, eczema, per cent of men in England Physiotherapy.stretching midwives otitis media, lactose and Wales have experienced intolerance and asthma. For it at some point in their lives. It recommends that:IN THE UK there were some conditions, like otitis813,200 births in the year to media, there was also a The draft recommendations •all childbearing women30 June 2012 – the largest correlation between also look at assumptionsnumber of births since 1972 - surrounding ‘honour’, and should be given evidence-according to the latest recommend that staff do not based information andgovernment figures (Office let their beliefs stop them advice about pelvic floorfor National Statistics (ONS) from identifying and muscle exercises and an2013). More than a quarter responding to ‘honour’ opportunity to discuss pelvicof these babies (25.9 per violence and abuse. care with a qualifiedcent) were born to a foreign- healthcare professional;born mother, up slightly on I Midwives can commentthe previous year. Eleven on the guidance at: •in cases where womenyears ago only one in six new www.nice.org.uk/guidance/imothers had been born ndex.jsp?action=folder&o=6 experience a problem withoverseas. 4782 Final guidance will be incontinence and pelvic floor published in February 2014. muscles, there should be a Royal College of Midwives clear referral pathway to aChief Executive Cathy Fertility and tissue specialist physiotherapist;Warwick said the baby boom regulators to remainwas placing considerable separate •midwives should bepressures on maternity THE FERTILITY and human provided with a new set of tissue regulators - the learning resources to Human Fertilisation and improve their knowledge and skills in this area.

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12 • Narrative pedagogy September 2013 • THE PRACTISING MIDWIFENarrative pedagogy inmidwifery educationA pioneer of SUMMARY Narrative pedagogy is an approach to midwifery educationnarrative pedagogy, which can promote strategies for teaching and learning whichAndrea Gilkison effectively prepare graduates for the complex nature of midwiferyexplains that this practice. Knowledge and skills are fundamental to midwifery practice,approach to the but knowing about how to use them is the art of practice. Teachingteaching of midwifery can and learning midwifery skills and competencies is straight forward inhave a significant impact comparison to teaching and learning about the art of midwifery, yeton the art of practice both are essential for safe practice. Narrative pedagogy may be one way that enhances undergraduate midwifery students’ learning about the art of practice. Keywords Pedagogy, midwifery education, narrative pedagogy, narrative-centred curriculum Author Dr Andrea Gilkison, midwifery programme leader at AUT University, AucklandIntroduction The art of midwifery of its foundations in behaviouralMidwifery curriculum discussions often practice is knowing psychology (Diekelmann 1993). Thecentre on what content should be when, how, why and for impact of a behavioural pedagogicaltaught and what knowledge and skills whom to utilise learned approach has been that learning aboutmidwives need for practice. How knowledge and skills midwifery has been broken down intoteaching and learning will occur is separate courses, each with their ownoften not made explicit. It is assumed technology for childbirth, the prescribed content and learningthat teaching and learning will happen educational environment and economic outcomes, which need to be passed inthrough a sequence of lectures, imperatives (Gilkison et al 2013). The order that the student can move ontotutorials and clinical practice. Pedagogy pedagogical approach which has the next part of the programme. Tois about how teaching and learning underpinned many educational become a midwife, each learninghappens and has been defined as the programmes since the 1960s has been outcome for each course must bephilosophical underpinning of termed ‘behavioural pedagogy’ because passed. This approach sometimes leadseducation (Diekelmann and to students compartmentalising theirDiekelmann 2009). learning and not always carrying their learning from year to year or fromBehavioural or narrative pedagogy theory to practice. Whilst behaviouralMidwifery education has been pedagogy can meet the needs ofinfluenced by many diverse factors learning about knowledge and skills forsuch as political and social drivers, midwifery, midwifery actions cannot be

THE PRACTISING MIDWIFE • September 2013 Narrative pedagogy • 13deduced simply from knowledge and The role of the teacher been introduced into Aucklandapplication of knowledge, because in the narrative tutorial University of Technology’s (AUT)midwifery practice occurs within groups is to facilitate undergraduate midwifery programme.complexity and the context of women’s the discussion, When narratives are central to aindividual uniqueness. Knowledge and interpretation and curriculum, narrative pedagogy may beskills can be learned from lectures, thinking process stimulated through the shared dialoguetextbooks and practice, but becoming a that occurs. A narrative-centredmidwife is much more than acquiring learning which comes from narratives. curriculum emphasises the importanceknowledge and skills. The art of of students determining their ownmidwifery practice is knowing when, How has narrative pedagogy been learning based on their interpretationhow, why and for whom to utilise adopted? of narratives and teachers facilitatinglearned knowledge and skills. Narrative Dahlberg et al point out that in learning in tutorial groups rather thanpedagogy may be one way that narrative pedagogy the emphasis is not solely through lecturing. The approachenhances learning about the art of merely on sharing stories but on which has been adopted at AUT is topractice. “collectively interpreting the common introduce each of the main topics of meanings and significances of the some courses with a narrative session Diekelmann (2001) emphasised that story” (Dahlberg et al 2003: 52-53). An with the whole class of studentsnarrative pedagogy can underpin any example of this is in a postgraduate together (may be up to 110 students).teaching strategy; it is not a particular midwifery course where McAllister et al The narrative to begin may be providedteaching method. The important aspect (2009) used narrative pedagogy to by a woman, a midwife, the studentsof narrative pedagogy is the emphasis engage students and foster a learning themselves or in one case a digitalon dialogue between teachers and community. Students read a novel with narrative, which uses a combination ofstudents, which does not always occur layers of complexity called ‘The Birth images, music, narration and text toin a traditional lecture situation. The House’. The dialogue about the novel create a multidimensional narrativedialogue which occurs when teachers between students and teachers was (Gazarian 2010). After listening to theand students interpret narratives found to awaken students’ political narrative, the students are divided intotogether may support students better consciousness through showing the groups of 15-20, each with a teacher, toto develop the ability to listen to perspective of a dominant or a interpret and discuss the narrative andwomen, interpret their narratives and marginalised position. what it meant for midwifery practice.to make individualised clinical The purpose of the first tutorial,decisions. A narrative-centred curriculum has immediately after the narrative session, is for students to interpret the narrative Undoubtedly midwives have always they have just heard, before furtherlearned about practice through sharing brainstorming and analysing thestories, but in terms of formal narrative using an adapted problem-education, those stories have been seen based learning process (Boud andas examples rather than a recognised Feletti 1997).way of learning midwifery. A narrativepedagogical approach values the Students explore the issues which arise from the narrative, discussing Now available to subscribers online. them and deciding what they already www.ingentaconnect.com/ know about the issues raised from the content/mesl/tpm narrative (activating prior knowledge). The student group then identifies gaps• Register free at www.ingentaconnect.com/register/ in their knowledge and what they• Following registration, select Personal subscriptions or Set up would need to learn about in order tosubscriptions for institutional further understand the issues. Each• Select the The Practising Midwife and enter your subscription group then jointly decides on a list ofnumber topics they will focus on for the week.• You will be notified by email once your online access has been Students’ learning is therefore based onactivated what they determine are the important learning issues raised by the narrative and what they already know about the M

14 • Narrative pedagogy September 2013 • THE PRACTISING MIDWIFEtopic. It is expected that students’ A midwife needs to Referenceslearning objectives would coverbiological science as well as sociological critically evaluate Boud D and Feletti G (eds) (1997). The challengeand psychological issues, ethics and of problem-based learning (2nd ed), London:midwifery practice. evidence, support Kogan Page. After a two week period of lectures, alternative choices, Dahlberg K, Ekebergh M and Ironside PM (2003).tutorials and independent study, 'Converging conversations fromtutorial groups meet again to feed back reflect on her own phenomenological pedagogies: toward aon their learning around the group’s science of health professions education'. In:learning objectives at the end of that practice and make Diekelmann (ed). Teaching the practitioners offortnight. The purpose of the narrative care: new pedagogies for the healthfeedback tutorial is to review the clinical decisions in a professions, Wisconsin: University of Wisconsingroups’ learning objectives. This is an Press.opportunity for students to help each myriad contextsother to understand the topics they Diekelmann N (1993). 'Behavioural pedagogy: ahave been studying, to debate different students reflected on knowledge, Heideggerian hermeneutical analysis of thesources of information (for example: values and beliefs and related those to lived experience of students and teachers inwhy a textbook might say one thing the narrative and midwifery practice; a baccalaureate nursing education'. Jour Nursand an article something different) and skill which is the cornerstone of the art Ed, 32: 245-250.to discuss the ways in which their of practice. Students felt an emotionallearning relates to midwifery practice. involvement with the narrative and Diekelmann N (2001). 'Narrative pedagogy: recognised their own values and beliefs Heideggerian hermeneutical analyses of lived The role of the teacher in the in relation to those of the narrator, experiences of students, teachers andnarrative tutorial groups is to facilitate which helped them to see the woman’s clinicians'. Adv in Nurs Sci, 23(3): 53-71.the discussion, interpretation and perspective, a skill which could be takenthinking process. Teachers have into practice. The art of midwifery Diekelmann N and Diekelmann J (2000).additional roles of ensuring a safe practice cannot be explicitly taught, but 'Learning ethics in nursing and genetics:environment for students to share their interpretation of narratives can help narrative pedagogy and the grounding ofviews, to facilitate the group process, to understanding of the art of practice to values'. Jour Ped Nurs, 15(4): 226-231.ensure that students stay on track with happen.their learning, that no one student Diekelmann N and Diekelmann J (2009).dominates the group and that all Knowledge and skills are essential for Schooling, learning, teaching: toward narrativestudents participate. midwifery practice, but on their own pedagogy, Bloomington: iUniverse. are insufficient. Making appropriateWhat is the evidence for narrative judgements is critical for midwifery. A Gazarian PK (2010). 'Digital stories: incorporatingpedagogy? midwife needs to critically evaluate narrative pedagogy'. Jour Nurs Ed, 49(5): 287-One consistent finding which has evidence, support alternative choices, 290.emerged from studies into narrative reflect on her own practice and makepedagogical approaches, is that when a clinical decisions in a myriad contexts, Gilkison A (2011). Implementing a narrative-learning environment fosters modifying the approach in the light of centred curriculum in an undergraduateinterpretation of narratives, a space is the woman’s response. A narrative- midwifery programme: a hermeneutic studycreated for dialogue, reflection and centred curriculum is one way that (doctoral thesis). Auckland: AUT University.thinking about subject matter in a learning about the art of midwiferydifferent way from the thinking which practice may be enhanced. The art of Gilkison A, Giddings L S and Smythe L (2013). 'Themight happen in a lecture environment practice matters for midwifery, and is at shaping of midwifery education in Aotearoa(Diekelmann and Diekelmann 2000; risk of being sidelined unless explicit New Zealand'. NZ Coll Midw Jour, 47(4): 18-23.Gilkison 2011; McAllister et al 2009; strategies, such as those of narrativeMcGibbon and McPherson 2006; pedagogy, are written into curricula. McAllister M, John T, Gray M et al (2009).Vandermause and Townsend 2010). TPM 'Adopting narrative pedagogy to improve the student learning experience in a regional In the undergraduate midwifery Andrea Gilkison is midwifery programme Australian university'. Contemp Nurse, 32(1-2):programme at AUT, Gilkison (2011) leader at AUT University, Auckland 156-165.found that when narratives werecentral to the learning environment, McGibbon EA and McPherson CM (2006). 'Interpretive pedagogy in action: design and delivery of a violence and health workshop for baccalaureate nursing students'. Jour Nurs Ed, 45(2): 81-85. Vandermause RK and Townsend RP (2010). 'Teaching thoughtful practice: narrative pedagogy in addictions education'. Nurse Ed Today, 30: 428-434.

THE PRACTISING MIDWIFE • September 2013 Evaluation of learning • 15The role of the mentor inevaluating learningClaire Bunyan and Louise SUMMARY This paper aims to give an overview of the role of theLawson describe the role of mentor within the sphere of the evaluation of learning, withthe mentor in the process particular emphasis on the intermediate interview and studentof evaluation reflection on their learning experience as formal tools for evaluation. Although the terms ‘evaluation’ and ‘assessment’ are often used in similar contexts, it is important to distinguish between the two concepts. The importance of evaluation of learning cannot be over emphasised as it is an important part of ensuring that students develop as expected (Nursing and Midwifery Council (NMC) 2008). Therefore, failure to evaluate learning can have a negative impact on the student and their learning throughout their programme of study. Keywords Evaluation, learning, students, feedback, midwifery education, mentor Authors Claire Bunyan, midwife in West Hertfordshire NHS Trust and Louise Lawson, senior lecturer in adult nursing at the University of HertfordshireWhat is evaluation of learning? The mentor is the ideal approaches tailored to the learner’s MDomain four, within the NMC’s person to evaluate needs.standards to support learning and learning, which canassessment in practice (Nursing and take the form of verbal Application to practice basedMidwifery Council (NMC) 2008) and written feedback, learning in the midwifery settingsuggests that mentors should reflection and The preliminary interviewcontribute towards the evaluation of formative assessment Student documentation usuallystudent learning, thereby recognising includes the initial, intermediate andaspects for change. Chow and Suen the learning experience (it is the final interviews, which can be useful(2001) suggest that the mentor is the learning outcomes that are important), tools to evaluate student learningideal person to evaluate learning, or whether it is the quality of the (Gopee et al 2004). The preliminarywhich can take the form of verbal and teaching activities and learning interview should be completed early inwritten feedback, reflection and experiences (the process) (Morrison the placement (Hand 2006), with theformative assessment. Therefore, good 2003). On a practical basis, mentors existing level of knowledge anddocumentation must be maintained, would usually adopt a mixture of experience being valued and discussedproviding evidence of the student’s (Fisher and Webb 2008). It can belearning journey (Duffy 2004). The ideal challenging to allow time for astrategy for evaluating student learning preliminary interview in a busydiffers, depending on the situation and maternity unit; however an informalskills involved (Goldenberg and Dietrich discussion can provide useful2002); however, the mentor could information, which can be documentedconsider whether it is the product of later. The evaluation process should be

16 • Evaluation of learning September 2013 • THE PRACTISING MIDWIFEcontinual, evolving and inclusive of the The evaluation process views questions from the mentor asstudent, thus engaging them in the non-threatening (Gardener 2006). Thislearning experience and ensuring should be continual, allows the mentor to establish thestudent-centred learning. student’s understanding, reinforce good evolving and inclusive practice and encourage developmentTools for evaluation (Bairns and Paterson 2005). The mentorThe intermediate interview of the student, thus must remember that each student is anUsually half way through a practice individual and their teaching style mustplacement, the mentor and student will engaging them in the be adapted to the student’s needshave a formal discussion about progress (Goldenberg and Dietrich 2002). At theand re-set objectives for the remainder learning experience end of each shift it would be valuableof the placement (Rassool and Rawaf for the mentor to ask the student how2007). Mentors have an obligation to and ensuring student- they think they have done, offeringevaluate student learning to ensure positive feedback and suggesting somethat the student, as a future centred learning areas for development (Gopee et alpractitioner, is safe and provides 2004). Taking this time will allow theevidence-based care (Parker 2009). constructive and developmental, student to raise any immediate issuesTherefore, failure to evaluate learning helping to build their confidence in or concerns that they have. The mentorcan lead to a student progressing their own abilities, encourage further can therefore reflect on their ownthrough the course without sufficient learning and ending with areas for experiences and encourage the studentknowledge and skills for safe practice. development being acknowledged and to do the same (Goldenberg and an action plan set (Sherwin and Deitrich 2002).Feedback to and from the student Stevenson 2011). This empowers theMuir and Sherwin (2011) remind us student to analyse and develop Conclusionhow the giving and receiving of themselves as practitioners. Evaluation of learning is an ongoingfeedback can benefit both mentor and Communication and interactive process, with the mentor using bothstudent. Feedback encourages the listening skills can be key to successful formal and informal tools to ensurestudent to reflect on their capabilities, mentoring as feedback from the that learning has indeed taken place.develop critical thinking and self- student allows the mentor to clarify The mentor should not assume that thereflection (Gaberson and Oermann what information the student/learner student has learnt what they think they2010) and make suggestions for future needs from the mentor, verify that the have taught. The intermediategrowth (Howard 2009). Feedback gives student/learner has received that interview can provide a more structuredthe mentor valuable information about information, and reflect on the evaluation of the student’s learning andthe strengths and weaknesses of their experience (Haidar 2007). An effective allows the mentor to raise anyown teaching strategies, enabling them way to evaluate understanding is to ask concerns; failure to do so can affect theto refine their future teaching (Hill the student to explain and perform a student’s learning. Evaluating learning2007). Feedback between the mentor clinical procedure to another student or provides the mentor with the feedbackand student should be an interactive woman (Roberts 2008); this increases to adapt their teaching styles for thecommunication given in a timely their confidence in their abilities and individual student and generally. Whilstmanner (McKimm 2009), informing the allows the mentor to evaluate how the student is an adult and must takestudent of whether they are achieving effective their teaching has been responsibility for their learning, thethe expected standards (Hill 2007). (Goldenberg and Dietrich 2002). This mentor also has a responsibility to actCommunity midwifery placements, method can also be used to develop as a role model, to actively look forwhere the mentor and student travel their skills. For example: they can start appropriate learning opportunities andtogether between visits, offer a perfect by performing a set of observations, to support the student to become a safeopportunity for regular feedback and then moving on to performing the practitioner. Domain four from thediscussion. Hospital based whole postnatal check. Whilst NMC standards to support learning andopportunities include the time remaining professional, the mentor assessment in practice (NMC 2008)following birth, after transferring the should try to build a rapport with the highlights that mentors mustwoman to the postnatal ward or student to encourage dialogue between determine strategies for evaluatingdischarging her. Feedback to the them and ensure that the student learning in practice. Therefore, thestudent needs to be critical, mentor’s role in the evaluation of

THE PRACTISING MIDWIFE • September 2013 Evaluation of learning • 17 learning is key to ensure that high Learning in Health Soc Care, 8(1): 33-46. Howard S (2009). ‘How to make your teaching standards of proficiency are met both in Gaberson KB and Oermann MH (2010). Clinical effective’. In: Hinchliff S (ed). The Practitioner pre- and post registration. TPM as Teacher, 4th edition. Edinburgh: Churchill strategies in nursing, 3rd edition, New York: Livingstone. Claire Bunyan is a midwife in West Springer Publishing Company. Hertfordshire NHS Trust and Louise Gardener F (2006). ‘Using critical reflection in McKimm J (2009). ‘Giving effective feedback’. Lawson is a senior lecturer in adult research and evaluation’. In: White S, Fook J, Brit Jour Hosp Med, 70(3): 158-161. nursing at the University of Hertfordshire Raine R et al (eds). Critical reflection in health and social care, Maidenhead: Open University Press. Morrison J (2003). ‘Evaluation’. Brit Med Jour, References Goldenberg D and Dietrich P (2002). ‘A 326: 385-387. humanistic-educative approach to evaluation Bairns I and Paterson IM (2005). ‘Clinical in nursing education’. Nurse Ed Today, 22(4): Muir F and Sherwin S (2011). ‘Assessing and practice and placement support: supporting 301-310. evaluating students on placement’. Brit Jour learning in practice’. Nurse Ed in Prac, 5(1): 3-9. Gopee N, Tyrrell A, Raven S et al (2004). ‘Effective School Nurs, 6(5): 233-236. clinical learning in primary care settings’. Chow FLW and Suen LKP (2001). ‘Clinical staff as Nurs Standard, 18(5): 33-37. NMC (2008). Standards to support learning and mentors in pre-registration undergraduate Haidar E (2007). ‘Coaching and mentoring assessment in practice, London: NMC. nursing education: students’ perceptions of nursing students’. Jour Nurs Managem, 14(8): the mentors’ roles and responsibilities’. Nurse 32-35. Parker P (2009). ‘What should we assess in Ed Today, 21(5): 350-358. Hand H (2006). ‘Promoting effective teaching practice?’ Jour Nurs Managem, 17(5): 559-569. and learning in the clinical setting’. Nurs Duffy K (2004). ‘Mentors need more support to Standard, 20(39): 55-63. Rassool GH and Rawaf S (2007). ‘Learning style fail incompetent students’. Brit Jour Nurs, Hill F (2007). ‘Feedback to enhance student preferences of undergraduate nursing 13(10): 582. learning: facilitating interactive feedback on students’. Nurs Standard, 21(32): 35-41. clinical skills’. Int Jour Clin Skills, 1(1): 21-24. Fisher M and Webb C (2008). ‘What do Roberts D (2008). ‘Learning in clinical practice: midwifery mentors need? Priorities and the importance of peers’. Nurs Standard, impact of experience and qualification’. 23(12): 35-41.pebble uk_Pebbel UK 23/04/2013 13:47 Page 1 Sherwin S and Stevenson L (2011). ‘Assessing the learning needs of students’. Brit Jour School of Nursing, 6(1): 38-42. Graduated Compression Call To Request Brochures Maternity Hosiery Freephone Microfibre Opaque – Knee Highs, Thigh Highs & Maternity Tights 0800 433 4757 Compression Thigh Highs – 30-40, 20-30, 18-21, 15-20, 12-15, 10-15 Ideal for prevention & relief of: 20-30 mmHg mmHg graduated compressions – Varicose Veins – Varicose Vulva – Closed Toe, Open Toe & Footless Designs – Venous Thromboembolism – Oedema – Opaque & Sheer Fabrics – Thrombosis & DVT – Venous InsufficiencyMTaSiogmlihatdnse1aO8p-Wa2oq1nudemeSrmuHMpgopdoretl Help Prevent Confusion – Our research shows MeKdniWeeeHigihgthCso2m0-p3r0esmsimonHg the need to indicate an mmHg/class when recommending compression/ support hosiery to your patients. Not all support hosiery is made with an mmHg. www.pebbleuk.com





20 • Community simulation September 2013 • THE PRACTISING MIDWIFEBSI not CSI: birth sceneinvestigation - a communitymidwifery simulationWith her second SUMMARY Educating students in sophisticated clinical simulationyear students centres, whereby students are exposed to low and high fidelityhaving had a equipment, is gaining popularity. It is considered beneficial to createsuccessful learning the most authentic environment to enhance learning. The Professorexperience, Joy Bernard Knight House at the University of Glamorgan, originallyJames explains where designed as an environment for forensic science students, was utilisedsimulation can go from to simulate a community midwifery scenario. Midwifery studentshere undertook a pilot simulation exercise in this environment, which they found a motivating learning experience, confirming the high level of authenticity of the environment. This is a positive learning tool. Keywords Simulation, learning, community scenario, student midwives, clinical skills Author Joy James, senior lecturer in midwifery at the University of Glamorgan (now the University of South Wales)Introduction and context It was a realistic the nursing and midwifery curriculumIn addition to an established, state of community with the University. Student midwivesthe art clinical simulation centre within environment that any undertake simulation in all three yearsthe faculty of Health, sport and science, midwife could expect of the Bachelor of Midwifery course,the University of Glamorgan in 2009 to encounter relevant to the modules studied, usingundertook a £15m refurbishment of low-fidelity equipment for basic skillsthe upper Glyntaff campus, providing a acquire the requisite skills. However, through to high fidelity sophisticatedvibrant learning environment, this house was also a flexible learning manikins for simulating more complexenhancing teaching and support space and, on inspection, it became scenarios. This paper outlines thefacilities for science and sport courses. apparent that it could be used to experiences of using a crime sceneAlong with science laboratories and simulate a community midwifery house facility for a communityspecialist crime scene suites, a setting. simulation with student midwives indedicated ‘scenes of crime’ house, the their second year.Professor Bernard Knight building, was Simulation is well embedded in bothdeveloped. Formerly the school Backgroundcaretaker`s accommodation, this was Simulation takes various forms, all withorganised primarily for crime scene a place in midwifery education, andscenarios, providing a simulated indeed it is not a new concept, withenvironment for forensic students to early adaptations of equipment

THE PRACTISING MIDWIFE • September 2013 Community simulation • 21recorded in the literature (Gelbart It was also an would begin on the doorstep when it M1998). Simulation suites have also been opportunity to practise was answered. Theoretical activitiesdeveloping at speed over the last 20 managing an relevant to the scenario were set inyears in healthcare education (Ricketts uncooperative client, place for remaining groups awaiting2011), in an attempt to replicate the putting communication their turn. Each group democraticallyclinical environment and in some and rapport elected one person to be the midwifecircumstances to supplement the establishment skills to whilst the others were given a checklistclinical experience where placements the test of desirable behaviours to observe andwere at a premium (Akhtar-Danesh et score when the scenario was underway.al 2009). Psychological fidelity is also to develop a scenario to pilot the use of Following each group`s simulationdiscussed in relation to realism and the the ‘house’. With this in mind an experience, a de-briefing session wassubsequent response from the student antenatal scenario was developed and undertaken with the whole group in a(Davis 2005). The literature on the environment was prepared in classroom.simulation is vast, not only in terms of advance; even though it was set up forexamining its effectiveness as a forensic students, it was a realistic Discussion/limitationslearning tool (Shinnick and Woo 2012; community environment that any Four groupsRoh et al 2011) but also its challenges midwife could expect to encounter. The ‘mother-to-be’ (lecturer) and(Harder et al 2012; Berragan 2011; Apart from some specific props such as ‘midwife’ (student) remained inRicketts 2011). Its use as a method to community bag, hand-held notes and a character throughout, being responsivedevelop critical thinking and diagnostic disguise for myself undertaking the role to the dialogue and, although commonskills has also been explored (Lasater of the woman (wig, pyjamas and fake themes emerged in each of the four2011; McKenna et al 2011), along with belly) the scene was much as it had been. groups, the scenario progressedthe question of successful transfer of differently each time, depending on thelearning from the simulated Preparing the students individual conversational styles,environment to the real world (Bligh A pre-brief took place and students mirroring the variation in clinicaland Bleakley 2006). The need for were split into four groups of three. practice.thorough planning is highlighted by Each group in turn was instructed tomany (Ricketts 2011; Childs and present themselves at the ‘house’, Testing skillsSepples 2006), as is the comfort of the knock at the door and the scenario Second year students are required toinstructor to utilise the method (Harder build on the ‘normal’ experiences theyet al 2012). accrue in year one, and the potential risks which can be expected in thePreparing the environment second year were indicated on theHaving had some experience of working checklist. Several physical props werewithin the simulation centre with evident, in the environment, whichstudent and post-registration midwives, aimed to prompt discussion, during theI was pleased to have the opportunity interaction, about issues such as a poor

22 • Community simulation September 2013 • THE PRACTISING MIDWIFEhome environment, aspects of safety, It was evident that the Referencesdomestic abuse and child protection. It ‘house’ could be utilisedwas also an opportunity to practise in several ways by the Akhtar-Danesh N, Baxter P, Valaitis R et almanaging an uncooperative client, midwifery team with (2009). ‘Nurse faculty perceptions ofputting communication and rapport small adjustments to simulation use in nursing education’. Westernestablishment skills to the test. In the props to simulate a Jour of Nurs Res, 31: 312-329.pre-brief it was emphasised that this different scenario, be itwas a learning exercise, so students ‘normal’ or Berragan L (2011). ‘Simulation: an effectivewere not expected to be ‘perfect’ and ‘complicated’ pedagogical approach for nursing?’ Nursethat further learning would be acquired Educ Today, 31: 660-663.in and following the debrief. A trusting groups to learn from each other - andand supportive relationship with the exploring the use of filming and Bligh J and Bleakly A (2006). ‘Distributing meansstudents enhanced the experience. playback could help to facilitate this. to hungry learners: can learning by simulation become simulation of learning?’First visit Conclusion Med Teacher, 28(7): 606-613.The experience provided rich learning The evaluation indicated studentsfor all involved. This was apparent in benefited from the simulation exercise. Childs JC and Sepples S (2006). ‘Clinical teachingthe debrief session that followed. As The environment was authentic and the by simulation: lessons learned from athis was a first visit to the ‘house’, it simple scenario provided valuable complex patient care scenario’. Nurs Educadded a layer of realism to the learning on a clinical and theoretical Persp, 27(3): 154-158.simulation, replicating a first home visit level. As a result of the pilot it wasin the community and the anxiety that evident that the ‘house’ could be Davis C (2005). ‘The perfect patient’. Nurs Stand,can be present when entering unknown utilised in several ways by the 26(20): 20-21.territory. We were able to discuss lone midwifery team with small adjustmentsworker policy and safety issues for to props to simulate a different Gelbart NR (1998). The king’s midwife: a historymidwives working in the community scenario, be it ‘normal’ or ‘complicated’. and mystery of Madam du Coudray,and how to generate support in The students indicated they would very California: University of California Press.challenging circumstances. much like to undertake further learning there. From a lecturing perspective, Harder NB, Ross CJM and Paul P (2012).Learning from the experience thorough preparation is essential as are ‘Instructor comfort in high fidelityKneebone (2006) and Schiavenato pre- and debriefs with the students. simulation’. Nurse Educ Today, pii: S0260-6917(2009) raise issues on the authenticity Additionally for the lecturer a personal (12)00285-7. doi: 10.1016/j.nedt.2012.09.003.of simulation environments. In this reflective evaluation of the individualenvironment the students remarked simulation exercise as a learning tool Kneebone R (2006). ‘Crossing the line:that they found it extremely authentic would enable further development of simulation and boundary areas’. Simul inrating the experience highly successful. the exercise. The use of filming could Healthcare, 1(3): 160-163.Suggested improvements included also be explored to maximise thehaving an interaction with a husband or learning for all involved. TPM Lasater K (2011). ‘Clinical judgement : the lastpartner, especially as there were frontier for evaluation’. Nurse Educ in Prac,suggestions of domestic abuse in the Joy James is senior lecturer in midwifery 11(2): 86-92.scenario. Introducing more participants at the University of Glamorgan (now theinto the scenario will be considered in University of South Wales) McKenna L, Bogossian F and Hall H (2011). ‘Isfuture bearing in mind practicality and simulation a substitute for real life clinicalresource implications. A scenario could experience in midwifery? A qualitativebe developed using the students examination of perceptions of educationalthemselves to take on different roles, leaders’. Nurse Educ Today, 31(7): 682-686.but with thorough planning andexecution. An observation as lecturer is Ricketts B (2011). ‘The role of simulation forthat although similar themes emerged learning within pre-registration nursingin each group it was clear each group education – a literature review’. Nurse Educevolved the scenario in a very different Today, 31: 650-654.way. It would be beneficial for all Roh YS, Lee WS, Chung HS et al (2011). ‘The effects of simulation-based resuscitation training on nurse self-efficacy and satisfaction’. Nurse Educ Today, 33(2): 123-128. Schiavenato M (2009). ‘Re-evaluating simulation in nursing education: beyond the human patient simulator’. Jour Adv Nurs, 48(7): 388-394. Shinnick MA and Woo MA (2012). ‘The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students’. Nurse Educ Today, 10.1016/j.nedt.2012.04.004.

THE PRACTISING MIDWIFE • September 2013 History of midwifery education • 23Charting the history ofmidwifery educationGina Finnerty,Anna Bosanquet SUMMARY Despite the recent popularity of exploring the history ofand Dawn Aubrey look back at midwifery practice, there has been minimal attention paid to thethe history of midwifery history of midwifery education. The purpose of this paper is to displayeducation,emphasising the a visual map and timeline of midwifery education from the eighteenthvalue of High Coombe,a teacher century, when formal midwifery programmes were introduced, to thetraining college for midwives present day. The paper will be inclusive of the history of midwifery teaching through the use of the High Coombe College archives (Lorentzon et al 2008). Prior to the eighteenth century, processes for learning midwifery were informal and unregulated. Traditional apprenticeships were gradually replaced by formal, regulated educational midwifery programmes, which were assessed. Midwifery teacher training finally became established in the twentieth century. Keywords Education, history, midwifery teacher training Authors Gina Finnerty, Anna Bosanquet and Dawn Aubrey, senior lecturers in midwifery at Kingston University and St George’s University of London18th century: from private Enlightenment, as well as growing whom they were responsible for Mapprenticeship to institutional competition from man-midwives. conducting most of the births. Regularteaching lectures were given by male doctorsPrior to the 18th century there was no From the mid eighteenth century, linked in an honorary capacity to eachstructured midwifery education concerns about the health of the hospital, some of them highly esteemed.provision in England and little attempt population stimulated the On the completion of their education,by the state or professional establishment of charities providing students were awarded certificates.organisations at control. Some women maternity care for the ‘deserving poor’,worked as midwives with no recognised either in the newly established lying-in Poorer aspiring midwivesqualification or licence, sometimes hospitals or through numerous Poor women wishing to enterthrough an apprenticeship with their organisations attending women in their midwifery could seek employment atmother or grandmother. Most, through homes. Both these types of institution one of the domiciliary lying-in charities,a formal arrangement, became an introduced structured education for where they would work very hard for aapprentice to an established midwife. midwives. Enrolling as a pupil at a low salary, but where they would hospital was expensive, and only receive ‘on the job’ training. After two The eighteenth century saw the relatively well off women could afford years they could apply for a permanentintroduction of more structured the cost. Pupils were expected to live in job and their salary would be raised. Bymidwifery education, which reflected at the hospital where they would spend then each would have attendedwider cultural and societal changes three to six months working under the between two and 700 births. However,linked to the ideals of the auspices of the hospital matron, with

24 • History of midwifery education September 2013 • THE PRACTISING MIDWIFEtheir theoretical understanding was From the mid eighteenth in London in order to give female pupilslikely to be lacking, as teaching by the century, concerns about learning opportunities equal to those ofoverworked charity doctors was variable. the health of the men (Bosanquet 2009). population stimulatedTeaching the establishment of Margaret Stephen wrote a manualLike their male colleagues, women charities providing for her pupils in the form of a pocketcould also pay to enrol on private maternity care for the book. This demonstrated courage andmidwifery courses to undertake ‘regular ‘deserving poor’ entrepreneurship for a female midwifeinstruction’ in the form of a series of educator at that time.lectures, often delivered by some of the concerns that in order to maintain theirmost famous man-midwives of the era. professional dominance, men teaching Unfortunately, despite Stephen’s andBy now, midwifery had become a midwifery to women were withholding her colleagues’ efforts, the 19th centuryfashionable occupation for men (with from them essential knowledge. There suffered a demise in the role of thewhom women had to compete for is evidence of only one female midwife in England.business), and teachers contended with midwifery teacher, Margaret Stephen,each other through some ingenious who established her midwifery school 19th century: on the job learningteaching methods aimed at attracting There was resistance to the midwiferystudents. These included the use of profession, with a focus on science andmannequins with detachable parts to medicine. A traditional apprenticeshipdemonstrate and practise manual skills model continued, but the length ofand enhance understanding. These time this involved varied. The studentsmodels were made of leather, cloth or were exposed to rote learning and werewood; some even included body parts, expected to buy their own practicesuch as the bony pelvis or a fetal skull. A equipment (Leap and Hunter 1993).few were made of transparent glass to Pupils continued to pay to be trained inallow students to visualise physiologicalprocesses such as the feto-placentalcirculation. Such ‘machines’ werepopular throughout Europe. In 18th century England, there wereFront page of the pocket book whichdescribes Stephen as a ‘teacher ofmidwifery to females’.(Image accessed via Warwick University Library. [Photo reproduced from the Archive Collection of the Royal College of Midwives with the kindReproduction of original from the John Rylands permission of the Royal College of Midwives] University Library of Manchester

THE PRACTISING MIDWIFE • September 2013 History of midwifery education • 25lying-in hospitals. King’s College Midwifery is now an all skills laboratories is necessary to ensureHospital in London and other teaching student midwives are fit to practise athospitals trained nurses in midwifery graduate profession in the point of registration. Grading ofalthough it was not until the end of the practice has been introduced to ensure19th century that the first diplomas in the UK. The curriculum accurate assessment of all essentialmidwifery were awarded. Obstetricians clinical skills (Nursing and Midwiferyremained sceptical about the has had to be Council (NMC) 2007). All programmesprofessional status of midwives, but are quality assured by the NMC (NMCopinions shifted when the Midwives’ drastically changed 2009). Midwives are increasinglyInstitute was established in 1886, later undertaking postgraduate diplomas,becoming the Royal College of qualification. The syllabus for the Masters degrees and PhDs, andMidwives (RCM). This had a significant course was set and assessed by the Professors of midwifery are providingimpact on midwifery education. Central Midwives Board and included academic and research leadership. obstetrics, paediatrics and public20th century: establishment of health. Assessment included final Conclusionmidwifery regulation and formal examinations and a viva voce. Charting the history of midwiferyteacher training education through three centuriesHigh Coombe College The move to university education reveals how far the profession hasThe 1902 Midwives Act was passed. A In 1980 the CMB revised the advanced. Exploration of pastcentral tenet was the better education requirements related to midwife paradigms and perspectives shows thatof midwives and the regulatation of teacher training. The Advanced Diploma we cannot become complacent abouttheir practice (Stevens 2002). The in Midwifery (ADM) was introduced as our professional identity. High qualityCentral Midwives Board was set up, part well as the Post Graduate Certificate in education (both pre and postof its remit being to prepare future the Education of Adults (PGCEA). High registration) is essential and needs tomidwife teachers through instigation of Coombe College remained open for over be developed by academic leaders inthe Midwife Teacher’s Diploma (MTD), thirty years and was held in high esteem order for the next generations ofrun as a residential training course. In and affection by staff and students. In midwives to be able to practise safelypost war Britain, the Minister of Health, 1986 midwife teacher training was and intelligently for the benefit ofAneurin Bevan, had set up a working moved to the University of Surrey. women, their babies and families. TPMparty to examine all aspects of thematernity services, including the Three year midwifery diploma and Gina Finnerty, Anna Bosanquet and Dawntraining of midwives. In response to this degree programmes were introduced in Aubrey are senior lecturers in midwiferyreport a council was formed in 1949 to the 1990s and direct entry midwifery at Kingston University and St George’sestablish a residential college for the led to widened participation in higher University of Londontraining of midwife teachers. In 1950 education. Schools of midwifery movedthe first residential college for midwife from NHS hospitals to Universities. This Referencesteachers was opened in Kingston upon changed the landscape of midwiferyThames in Surrey. Sixteen students education. Bosanquet A (2009). ‘Inspiration from the pastwere enrolled every six months, not just (4): Margaret Stephen, protector of thefrom the UK but Australia, Burma, India, 21st century: expansion of profession’. The Pract Midw, 12(11): 31-32.Singapore, Sierra Leone and Uganda. evidence informed midwiferyStudents paid tuition fees and ‘board teaching and higher degrees Leap N and Hunter B (1993). The midwife’s tale,and lodging’. High Coombe College was Midwifery is now an all graduate London: Scarlet Press.known as the ‘virgin’s retreat’ and profession in the United Kingdom. Theteaching was reported by some to be curriculum has had to be drastically Lorentzon M (2008). Personal communication.‘mechanical, didactic and Victorian’ changed. This comes at a time when Lorentzon M, Marchant S, Duff E et al (2008).(Lorentzen 2008). demographics reveal an ageing midwifery lecturer workforce (RCM ‘Midwifery education in England, 1949-56’. Midwives employed by the National 2012). Widened participation is MIDIRS Midwifery Digest, 18(1): 19-26.Health Service could be seconded onto increasing. Blended learning is an NMC (2007). Grading practice, London: NMC.the MTD course with full pay, provided essential component for delivery of the NMC (2009). Standards for pre-registrationthey committed to two years of curriculum and simulation in technical midwifery education, London: NMC.teaching pupil midwives, post RCM (2012). The state of the maternity services, London: RCM. Stevens R (2002). ‘The Midwives Act 1902: an historical landmark’. Midw, 5 (11): 370-371.

26 • Pinards September 2013 • THE PRACTISING MIDWIFEMaintaining the passionfor pinardsHannah Smith SUMMARY Throughout my midwifery programme I have developed aexplains why the passion for the use of pinards; a skill that may be lost withinability to use a midwifery. It is often acknowledged that the use of pinardpinard is important stethoscopes prior to the use of electronic devices is best practicefor mother,baby (Royal College of Midwives (RCM) 2012), yet it is a practice that seemsand midwife to be losing its place. This article aims to share some of the benefits of using a pinard and encourages the reader to reflect on their own feelings towards using this tool in practice. I will analyse whether or not there is still a value for pinards following an event I experienced whilst on clinical placement. This reflection uses an adapted version of Driscoll’s Model of structured reflection (Driscoll 2000). Keywords Pinard, antenatal auscultation, fetal heartbeat, midwifery skills Author Hannah Smith, second year student midwife at the University of GlamorganThe event The pinard allows Analysis MWhilst working in a consultant midwives to continue The use of pinards is considered one ofantenatal clinic I was able to assist a working effectively the most basic midwifery skills at risk ofregistrar with palpations. When I first when the batteries of being lost (Wickham 2002b). The devicedid so I used my pinard to auscultate sonicaids run out, or was invented for obstetric use as itthe fetal heart prior to using a sonicaid. when these devices allows better transmission of the fetalThe registrar was surprised and break heartbeat than a binaural stethoscopeinformed me that he had not seen a (Montagu 2008). Johnson and Taylorpinard being used before and thought it hope that, by looking into the evidence (2011) state that the pinard may bewas an instrument no longer in use. I and research on pinards, I shall be able used to auscultate the fetal heart fromfelt quite dismayed by this comment, to discover further benefits and confirm 24 weeks. The need to wait so longparticularly as I was aware that the that the pinard is an important part of seems debatable, as I am often able tomajority of midwives don’t seem to use midwifery and not simply an artefact to hear with a pinard from 16 weeks,pinards anymore. Student midwives display in history museums. following teaching from a skilledoften question whether the use of midwife.pinards is helpful when so fewpractising midwives use them. I Benefitspersonally adore using my pinard and There are many benefits to using ahave found that women enjoy me using pinard, one being its economicit; this has often enhanced my rapport credentials; pinards do not requirewith women as it would seem more batteries or any particular maintenanceintimate than just using the sonicaid. I and can be made from natural carbon

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28 • Pinards September 2013 • THE PRACTISING MIDWIFEneutral material such as wood the abdomen whereas a pinard won’t the midwife’s ear, the pinard and the(Montagu 2008). Being able to use the so long as the bottom isn’t deeply maternal abdomen; this increasespinard allows midwives to continue engaged (Montagu 2008). Using a sound variance (Johnson and Taylorworking effectively when the batteries pinard first to auscultate allows the 2011). The midwife should remove herof sonicaids run out, or when these midwife to pick up the heartbeat more hand from the pinard whilstdevices break (Wickham 2002a) - an quickly when then using electronic auscultating to avoid creatingexperience I can personally recall from a devices, as it has already been located.community placement. Using a pinard first to Using a pinard auscultate allows the Pinards can assist in confirming To use the pinard, the midwife should midwife to pick up thefindings from a palpation (RCM 2012) begin by palpating the maternal heartbeat more quicklyand are useful when auscultating an abdomen to ascertain the baby’s when then usingoccipital-posterior or breech fetus position; it sometimes helps to ask the electronic devices, as it(Montagu 2008). Where there is woman where she herself feels her has already beendifficulty identifying an occipital- baby is lying (Wickham 2002a). The locatedposterior fetus, the midwife is likely to clearest sound will be heard in the areaonly hear the heartbeat with the where the fetal anterior shoulder liespinard, if placed beneath the umbilicus (Impey and Child 2012). Once this spot(Wickham 2002b). If there is a breech is determined there should be directpresentation the sonicaid may still find contact and gentle pressure betweena clear heartbeat in the lower regions of

THE PRACTISING MIDWIFE • September 2013 Pinards • 29extraneous sounds (Viccars 2009). If the Using a pinard prior to 2008). In countries where the pinard isfetal heart isn’t heard, the palpation and along with the use the only means of auscultating the fetalshould be repeated and the pinard tried of a sonicaid can heart, being able to use the pinard toin another spot (Wickham 2002a). optimise a midwife’s measure variability would be useful.Findings from this practice should clinical skills andalways be discussed with the woman enhance rapport Conclusion(Johnson and Taylor 2011). between the midwife Using a pinard prior to and along with and client the use of a sonicaid can optimise a Wickham (2002a) states that there is midwife’s clinical skills and enhancea degree of satisfaction in finding the heartbeat through their ear rather than rapport between the midwife andfetal heart with a pinard. I can confirm ‘hearing’ it (Wickham 2002b). The client. There is also the potential tothis from personal experience; when sound provided by the pinard is what I measure variability of the fetal heartlistening with a pinard, a midwife is can only describe as beautiful and I rate. I aim to continue developing myable to hear the ‘real’ fetal heart, rather often wish I could share this with the abilities with using the pinard: it is anthan an electronic rendition of it woman; yet being able to tap the sound important part of midwifery history(Viccars 2009). The midwife should on her wrist has often been an and is a valuable tool that deserves tocount the heartbeat for a whole minute endearing experience. have its place in current clinicalas suggested by National Institute of practice. TPMHealth and Care Excellence (NICE) Variability of heart rate(2012) guidelines. The number An interesting benefit for the use of Hannah Smith is a second year studentdisplayed on the screen of a sonicaid pinards is that the midwife can midwife at the University of Glamorganduring auscultation can be a double up measure variability of the heart byof the heart rate (Murray 2004). Using a counting the number of beats heard in Referencespinard decreases the chance of error a series of five second intervalshere, as the practitioner is counting (Wickham 2002b). The number of beats Driscoll J (2000). Practising clinical supervision,purely what they can hear (Murray 2004). should change each time, confirming London: Balliere Tindall. variability (Johnson and Taylor 2011).Drawbacks of electronic devices The lowest number found in five Impey L and Child T (2012). Obstetrics andElectric equipment has been found to seconds would be considered the gynaecology, 4th Edition. Chichester: Wiley-confuse fetal and maternal heart rates baseline and the higher figure would Blackwell.(Johnson and Taylor 2011). This can be show the degree of variabilitydetrimental as there have been cases (Montagu 2008). If there is no change Johnson R and Taylor W (2011). Skills forwhere seemingly successful ‘fetal’ the fetus could be asleep and the midwifery practice, Edinburgh: Elsevier.monitoring was carried out during exercise should be repeated again later,labour yet the baby was stillborn if there is decreased variability for Lirag N (2005). ‘Seeing and hearing baby in the(Montagu 2008). Viccars (2009) states longer than 40 minutes it may suggest womb’. Urban Baby and Toddler Magazine,that the pinard assures the midwife a deviation from normal, needing http://tinyurl.com/ok8pqjmthat it is fetal and not maternal sounds attention (Johnson and Taylor 2011).being heard. Murray (2004) supports The midwife may have awareness of Montagu S (2008). ‘In defence of the pinard’.this statement by informing us that the fetal movements whilst assessing Midwifery Matters, 118: 3-4.maternal pulse is rarely heard with a variability and the woman can be a partpinard. of the process by telling the midwife Murray M (2004). ‘Maternal or fetal heart rate? when she feels movement (Montagu Avoiding intrapartum misidentification’. JourRecognising the sounds Obst, Gynaec Neona Nurs, 33(1): 93-104.One of the difficulties with pinards isthat many midwives struggle to hear NICE (2012). Intrapartum care: clinical guidelinewith them. It took me a few months 55, London: NICE.before I was first able to hear with mypinard. I agree with Lirag’s (2005) RCM (2012). Evidence based guidelines forstatement that when using the pinard midwifery-led care in labour: intermittentyou are listening for a ‘vibration’ rather auscultation, London: The RCM Trust.than a sound. Some midwives wouldeven describe the sound as ‘feeling’ the Viccars A (2009). ‘Antenatal care’. In: Fraser D and Cooper M (eds). Myles: textbook for midwives, 15th Edition. Edinburgh: Elsevier. Wickham S (2002a). ‘Pinard wisdom: tips and tricks from midwives. Part one’. The Pract Midw, 5(9): 21-22. Wickham S (2002b). ‘Pinard wisdom: tips and tricks from midwives. Part two’. The Pract Midw, 5(10): 35-36.

30 • Using image-rich timelines in reflection September 2013 • THE PRACTISING MIDWIFETime to reflectSUMMARY In an attempt to introduce creative ways of reflecting, art Following on from her students’projects were included in group personal tutor sessions for student reflection on their learning,midwives. One was a reflective timeline drawn annually, documenting Stevie Walsh assesses the valuethe student’s own journey through a year. The intention was that this of using image-rich timelines toinformal and interactive activity may help the students to relax and enhance the learning experienceenjoy the reflective process, and also have some fun. Due to the highpressured risk management orientated nature of contemporarymidwifery this was to be a welcome contrast to many of thetraditional taught classes within the course. The student’s evaluationof the activity exceeded all expectations in terms of demonstratingtheir learning from the experience and that sharing had helped thembond as a group thus supporting and understanding each other better.This exercise fostered a culture of self awareness, relationshipbuilding, caring and support for colleagues, all crucial aspects ofwoman centred midwifery practice.Keywords Teaching and learning, reflection, building relationships,timelineAuthor Stevie Walsh, midwifery and practice education lecturer atRobert Gordon University in AberdeenIntroduction It promoted self professional standards.Learning from experience in not awareness, learning Learning is categorised into threedefined in terms of time spent in from reflection andpractice but by how experiences are relationship-building domains: cognitive (knowledge),understood and what meaning is then within the group affective (attitudes) and psychomotorgleaned in order to emerge with a new (skills) (Bloom 1956), so to meet withunderstanding, including actions awareness of their own attitudes and organisational expectations, therequired for future practice (Benner 1984). values, and of the skills they had activity needed to be a learning episode developed. It promoted self awareness, that could demonstrate a link to these, When planning the activity for a learning from reflection and rather than just being fun. Allgroup session at the end of the first relationship-building within the group. midwifery teachers are expected toyear, I decided that something reflective, facilitate learning using “enquiring,personal but also inclusive of the group Teaching and learning reflective, critical and innovativewas needed; one that would result in Midwifery education is learning- approaches” and also “facilitatesomething tangible that could be kept. outcome driven, with these outcomes integration of learning from practiceCentral to the activity was identifying being clearly and measurably linked to and academic settings” (Nursing andlearning along the way and the Midwifery Council (NMC) 2008a: 26).development, both personally and This activity was innovative andprofessionally, of the student midwife. reflective and promoted critical analysisThis activity fitted all three learning of past experiences through discussion.domains (see below) in that the It has been identified that the role ofstudents identified their knowledge the personal tutor is valued and couldgained, understanding of experiences, contribute toward greater student

THE PRACTISING MIDWIFE • September 2013 Using image-rich timelines in reflection • 31I felt that every actionmattered and had a bigimpact – mostlybecause many thingswere still newachievement and reduce studentattrition (Braine and Parnell 2011).Where there is a meaningful personaltutor/student relationship, where thestudent feels cared for and supported,students who may have otherwise leftthe course feel able to stay (NMC 2010).This activity, and the response from thestudents to each other’s stories,resulted in a better understanding onmy part of their journey so far.Reflection Students with their second year timelinesReflection on practice is embedded inmidwifery education and is a lecturer’s beliefs about many students’ into a wider context for me as a person, Mrequirement made explicit by the NMC struggle to meaningfully reflect on personally and professionally.”(NMC 2008b). However it has been practice. The idea was, if the reflectionsuggested that the use of structured was specifically personal to them, then A significant challenge for midwiferyreflective models may stifle critical the context and their understanding of educators is the theory-practice gap,thinking, thereby preventing deep reflecting on practice would develop. where students become confused whenlearning (Coward 2011). Moreover, the emotional connections to practice does not mirror evidence-based the story of their year would create theory studied in class. Part of the The timeline was designed to enable ownership and a new bubble of self personal tutor’s role is to encouragethe students to record, in a sequential awareness. Reflection ought to reflective practice in order to helpway, the high and low points of their generate new understandings, and the students make the links betweenjourney through their first year as fact that new understanding was theory and practice (Braine and Parnellstudent midwives. Many different gained was mainly evident after the 2011). This activity encompassed therepresentations were produced, such as end of the year two reflection, where students’ movements between theorytrees, roads, mountains, seascapes, the students noticed the difference and practice, and indeed severalgreenhouse and garden, rollercoaster, between their first drawing and their students commented on this withinplane flight, month by month calendar, second. One said, “Last year’s timeline is their first timeline, with one saying,snakes and ladders board and a CTG very detailed. I felt that every action “Theory into practice – lots ofwith the documentation underneath – mattered and had a big impact – mostly questions” and another writing, “Firsta diverse creative talent pool was because many things were still new. placement – into the unknown.emerging. Re-evaluation of experience, This year’s timeline puts my second year Realisation: theory/practice gap,” buta crucial aspect of reflection, occurred then showing further insight into thethrough discussion with their peerswho were able to suggest a differentinterpretation of some situations. Designing this activity was aninstinctive decision based on the

32 • Using image-rich timelines in reflection September 2013 • THE PRACTISING MIDWIFEgap by adding later, “Realisation: I don’t One student included qualified and one drawing herself aswant to practise like some of these now being tall enough to go on themidwives.” Others showed their her vision of herself as a rollercoaster, unlike the small self inunderstanding of their own building year two, and even smaller self in yearknowledge, with one student writing in midwife, featuring a one, her awareness of growth over thethe second year, “More knowledge, two years, evident.more questions.” plan of a birth unit ConclusionBuilding relationships where women were This article has identified some benefitsThe relationship midwives have with to student midwives of creativewomen (and each other) is a key aspect seen to be labouring reflective activities, in relation to seeingof woman- centred care and effective the bigger picture, self in context,practice. This activity, focused on the using birthing balls and recognising support from peers and thestudents’ experience, allowed them to context of theory for practice.tell their stories and supported pools Autobiographical reflections helpstrategies for progression to the next student midwives make sense of whatyear. It was facilitated by a personal valued it at the end. One student said, has happened, and identify how theytutor who knew them well, cared about “I am a keen learner and I thought I can deal with the challenges they face.them as individuals and a group, and could spend my time better,” andabout how they will practise as our another said, “initially I was Another activity is planned for thefuture midwives. Role models who apprehensive as I am not a creative future – the students will be making andemonstrate caring are an important person at all,” but went on to say, “I expressive representation of effectivepart of learning to be a compassionate found that once I got started, I really leadership – another crucial aspect ofand caring midwife. There were many enjoyed it. I found it therapeutic to midwifery practice. TPMcompassionate and empathetic think back over the year and how I feltexchanges during the story telling and at different points.” The intention had Stevie Walsh is midwifery and practicemany said that that had helped them to been that this activity would be done education lecturer at Robert Gordonunderstand the situations and feelings twice (at the end of each of the first and University in Aberdeentheir peers had experienced, empathise second years) but the students havewhen they had been similar to their requested that they do an end of third Referencesown, and connect with each other on year timeline, too, as they feel that itan emotional level as a result. will better prepare them for beginning Benner P (1984). From novice to expert: their practice as qualified midwives. excellence and power in clinical nursing Relationships within the peer group practice, California: Addison-Wesleyhave significant impact on the student A key aspect of reflection is identifying Publishing.experience. One student had drawn a new ways of doing things. At the end ofbig cloud in the middle of her first year the second year, one student included Bloom B (1956). Taxonomy of educationaltimeline with teardrop rain and the her vision of herself as a midwife, objectives: the classification of educationalname of her friend, who had left the featuring a plan of a birth unit where goals, New York: David McKay Company Inc.group, in the cloud – this had caused a women were seen to be labouring usingbig dip in her journey. Several students birthing balls and pools. Braine ME and Parnell J (2011). ‘Exploring students’had lows related to mentorship issues, perceptions and experience of personalwhich were always included in the The final parts of some second year tutors’. Nurse Educ Today, 31(8): 904-910.narrative where they featured in the timelines clearly demonstrate anxietytimeline, showing the impact poor about their final year, with one going Coward M (2011). ‘Does the use of reflectivementor/student relationships can have off a waterfall into the third year, one models restrict critical thinking and thereforeon students. having “stormy times ahead” in her sea, learning in nurse education? What have we the pilot of the plane putting her done?’ Nurse Educ Today, 31(8): 883-886.The journey continues seatbelt on, one being both scared andAt first, whilst the idea was not hopeful and a few being exhausted at NMC (2008a). Standards to support learning andrejected, in the evaluation some made the end of year two. However there are assessment in practice. NMC standards forit clear they had been sceptical about many positive ends to year two with mentors, practice teachers and teachers,the activity to begin with, but then many looking forward to being London: NMC. NMC (2008b). The code: standards of conduct, performance and ethics for nurses and midwives, London: NMC. NMC (2010). The MINT project report: midwives in teaching, London: NMC.

THE PRACTISING MIDWIFE • September 2013 SM.Net competition winner • 33What does midwifery mean to me?The winning entry for theStudentMidwife.NETelective placement toTanzania. Helen Braidexplains what midwiferymeans to herW hat a profound, complex question! It could feeling never changes. M be something asked at those university interviews for a place to study this incredible Miracle vocation - and, right now, as a third year It means the satisfaction of being part of a profession that isstudent midwife, the answer could be that it means exhaustion, not just a career, but a lifestyle. I have the privilege ofstress, headaches, financial hardship and even fear at the becoming part of a family’s history, part of their story thatthought of the overwhelming responsibility to come. will never be forgotten. It is humbling to think that I will always be remembered, that my actions can and do have a Yet midwifery means so much more to me, which is why I long lasting impact on a woman and her family that couldcontinue to persevere and progress through my studies, last for generations. Midwifery means carrying thatbecoming more excited about the goal I am so close to responsibility forever and being proud to do so.achieving. Midwifery will no doubt mean different things tothe many people who come across it: the expectant mother, It means becoming a small part of an everyday miracle. Ithe new father, the senior midwife will all have different get to witness love and respect deepening between couples. Iperceptions. But this writing is what it means to me; as a get to see women become mothers and men become fathers.mother, a sister, a daughter and, of course, as a soon-to-be- I see families being created and extended. I get to witnessqualified midwife. those important bonds form and sometimes have the immense responsibility of helping to strengthen them.Challenges Midwifery means assisting women in the transition toHas it meant hard work? Of course it has: the difficulty in motherhood, not just physically, but emotionally, too.persuading my family and friends that a career change atthirty was not madness; the stress of learning to studying Using our sensesagain, just to be considered for a place at university; the Midwifery is about making connections with women,hardship of being a student midwife, with long unpaid hours, families and unborn children; and learning to use thenever ending exams, essays and a dissertation. But then all simplest of tools: our senses. Touch, smell, sight, hearing andthe hard work is worth it. To be a part of something so the empathy enable us to do the most important job ofincredible - to be ‘with woman’ - is an honour, and that making those connections. These simple tools allow us to

34 • SM.Net competition winner September 2013 • THE PRACTISING MIDWIFEunderstand the growing child, the Midwifery means On her return from Tanzania, Helendeveloping mother, they allow us to reflected on her experience:reassure, understand and becoming a small part What a privilege to be given this trip ofcommunicate. a lifetime, to experience midwifery in of an everyday miracle Tanzania. It was everything I imaginedRepresenting women and more: at times scary and at othersMidwifery means helping a woman find obstetrician in Hungary and later amazing.within her the strength she didn’t think became a midwife. Throughout hershe had, believing in women at times career she has been constantly I cannot begin to describe thewhen they perhaps do not believe in persecuted and has been imprisoned by incredible and humbling experience itthemselves, encouraging them to listen the Hungarian government for her was to spend time with the Maasai. Toand believe in what their bodies can do. gentle, forward thinking treatment of be so welcomed and to be given theIt’s about being her voice when she is at birthing families. Despite this she has greater honour of being asked to attendher most vulnerable, protecting her never given up on midwifery, safely a Maasai birth in a mud hut, somethingrights, her dignity and her beliefs. helping the birth of over 9,000 new I know not many outside the MaasaiMidwifery is about being in the moment, lives, 3,500 of them at home (Kalef would have had the opportunity to do.being unassuming yet fully attentive, 2012b). She has opened a birth centre, Six hours in a dark, smoky mud hutbeing competent yet able to give educated midwives both in Hungry and with flies, chickens, cows and goats wassensitive, personalised care to the entire internationally, contributed to ten hard, especially knowing there waswoman and even her family, from the books and even featured in six films little help to be called on in aninside out. Enabling the woman to fully (Kalef 2012a). An annual holiday in emergency. But when I walked awayunderstand herself and reach her greatest Hungary called ‘Home birth day’ that from the hut having witnessed anpotential. Midwifery is about being able brings together hundreds of families, is almost blind Maasai elder, acting asto empower women, not just for their also attributed to her. Agnes’s passion midwife, deliver a healthy baby boy,journey to motherhood, but for life. and dedication mean that she I couldn’t stop smiling. Weeks later, at continues to fight for midwifery, her home, I received a message from theNormality passion now bringing people together tribe, telling me that they would neverMidwifery is about advocating from all around the world to fight with forget the woman who came to assistnormality, remembering that it is her. These people all have different their Maasai midwife, and that godmidwives, not physicians, who have backgrounds, but they will ensure that would always be with me; the womanattended birth for most of human midwifery will continue; voices will be who works hard!existence (Davis 2004). It should be heard and women’s rights will beremembered that where midwifery is at protected. Midwifery means being My trip to Tanzania was amazing,its strongest, as it is in Sweden, strong, independent and free thinking: the people so welcoming and themidwifery assisted birth remains a rebel with an important cause. experiences will stay with me forever.normal and that the countries with the I can’t wait to go back one day…and iflowest perinatal mortality rates believe That is what midwifery means to me you’ve ever considered going, do it! TPMin and make good use of midwives So that is what midwifery means to me.(United Nations Population Fund I am certain that as I continue to Helen Braid is a third year student(UNFPA) 2011; Davis 2004). develop as a midwife and as the world midwife at the University of Bedford changes around me, the meaning willAgnes Gereb change and develop too. But I also know ReferencesMidwives past and present around the that however that meaning may alter,world have been persecuted because of some things will always remain the Davis E (2004). Hearts and hands, 4th edition.their passion to advocate the normality same: midwifery will always meanof birth; because of their belief in the ‘being with woman’ and I know, as long California: Celestial Arts.rights and strength of women and their as I keep that in my heart, I will alwaysdesire to protect them. Agnes Gereb be the best midwife I can be! Kalef M (2012a). ‘Advocates join Hungariansymbolises exactly what midwiferymeans to me. Agnes is changing the midwife Agnes Gereb's fight for home births’.world, although she didn’t set out to dothat (Kalef 2012b). Agnes used to be an Vancouver Observer, 9th March. Kalef M (2012b). ‘Hungarian midwife Agnes Gereb changing the world’. Vancouver Observer, 25th September. UNFPA (2011). Midwifery around the world. The state of world's midwifery 2011: delivering health, saving lives, New York: UNFPA.

Reviews Pelvic floor secrets: 6 disregarded; the only mention of birth being in relation to weeks to confidence, unspecified ‘trauma’. During labour a well-functioning (or continence and sexual well-sprung) pelvic floor is crucial in increasing the flexion satisfaction of the baby’s head and in assisting the internal rotation of the baby’s head and later the shoulders. Thus, the health Russell Jenni of these pelvic structures is an absolute prerequisite for the achievement of normal birth. 2012, Filament Publishing, 225pp, £15.99, pbk ISBN 978 1 908 691 392 This criticism is aggravated by certain assumptions in the book, such as any male partner being a ‘husband’ and, In some ways the pelvic floor is similarly, that any sexual activity is inevitably penetrative rather like the placenta: both and heterosexual.are crucially significant in our lives, particularly in theearliest days, but they are quite unquestionably not given The book’s presentation is in many ways very attractive,the credit which they deserve. The placenta, in my with all pages having wide margins and the inclusion ofexperience, tends to be relegated to ‘yuck’ status; while many boxes to highlight points. The terminology isthe pelvic floor remains widely unknown and challenging due to the frequent references to the variousunrecognised. groups of muscles. Occasionally, though, more patronisingly reader-friendly terminology emerges in theJenni Russell’s book may represent an attempt to reverse form of, for example, ‘love muscles’ and ‘sitting bones’.the pelvic floor’s lack of public image and to provide it This mix becomes disconcerting when the seriouswith some degree of rehabilitation. Such an attempt is anatomical terms do not match the diagrams, such as inseriously overdue. pages 55/57.I’m not sure, however, that this book achieves these aims. Despite Jenni Russell’s achievement in ‘opening up’ thisAnd most definitely not for midwifery or midwives - in important topic, other issues relating to the content,their professional capacity, at least. The focus is largely on orientation and presentation of this volume make itthe female pelvic floor, though the male structures do difficult to commend.occasionally put in an appearance. The functions of this‘muscular hammock’ (Hendrick 1919), however, are Rosemary Manderconsidered only in terms of their role in maintaining Emeritus professor of midwifery at the University ofurinary continence and facilitating sexual enjoyment. EdinburghThe fundamentally important role of the healthy pelvic References: Hendrick AC (1919). ‘On backward displacements of thefloor in ensuring physiological birth is completely uterus’. Canadian Medical Association Journal, 9(10): 927-933.

36 • Cochrane corner September 2013 • THE PRACTISING MIDWIFE Umbilical cord antiseptics for preventing sepsis and death among newborns. Valerie Smith continues our seriesThis month we highlight the SUMMARY The aim of this bi-monthly column is to highlight CochraneCochrane Systematic Review Systematic Reviews of relevance to pregnancy and childbirth and toby Imdad et al (2013) on stimulate discussion on the relevance and implications of the review forumbilical cord antiseptics for practice. The Cochrane Collaboration is an international organisation thatpreventing sepsis and death prepares and maintains high quality systematic reviews to help peopleamong newborns,which make well-informed decisions about healthcare and health policy. Awas published in Issue 5 of systematic review tries to search for, appraise and synthesise existing2013 of the CDSR. research to answer a specific research question. The Cochrane Database of Systematic Reviews (CDSR) is published monthly online. Residents in countries with a national license to The Cochrane Library, including the UK and Ireland, can access the Cochrane Library online free of charge through www.thecochranelibrary.com Keywords Umbilical cord, cord care after birth, omphalitis, antispetics Author Dr Valerie Smith, lecturer in midwifery and post doctoral midwifery research fellow at Trinity College DublinBackground In these settings, the necrotizing fasciitis, develop. It is M death rate among all therefore important to keep the cordCutting the umbilical cord following infants with omphalitis stump and surrounding area clean untilbirth is a physical and symbolic gesture can be as high as 46 per full healing has been achieved.resulting in the anatomical separation centof mother and baby. In the days While there is general agreementfollowing birth the small part of the (McKenna and Johnson 1977), the about using sterile techniques whencord attached to the baby, the umbilical incidence of omphalitis in developing cutting the umbilical cord after birth,cord stump, begins to dry out, turn countries can be as high as 21 per cent there is less agreement on what is theblack in colour and eventually falls off (Mir et al 2011). In these settings, the best way to care for the cord in the(usually between five and 15 days after death rate among all infants with immediate days following birth (Zupanbirth). Before the umbilical cord stump omphalitis can be as high as 46 per cent et al 2004). The World Healthfalls off, the area around the stump may (Mullany et al 2009). This increases Organization (WHO) (1999) recommendsbe considered a healing wound and dramatically (up to 71 per cent) when keeping the cord clean and dry withoutthus a possible route for neonatal associated conditions, such as applying anything to the area. This isinfection. Infection of the cord stump is supported by the National Institute ofcalled omphalitis. Clinical signs of Health and Care Excellence (NICE)omphalitis include red or inflamed (2006). However, modern practicessurrounding skin, pus, bleeding and a commonly include the application offoul smell emanating from the cord. anti-microbials to the cord stumpAlthough a relatively rare condition in (Imdad et al 2013). These may includedeveloped countries, affecting between antiseptics (such as alcohol, silver0.2 and 0.7 per cent of newborns sulphadiazine, chlorhexidine, triple dye

World’s first of its kind Pregnacare® trial published in British Journal of Nutrition Pregnacare® tablets shown to benefit the health of pregnant mums and their babies in major UK trial As widely reported in the national press, Vitabiotics Pregnacare® tablets have been shown to benefit pregnant women and their babies in a major UK trial1, carried out by the Institute of Brain Chemistry and Human Nutrition at London Metropolitan University and the Homerton University Hospital. “TO THE BEST OF OUR KNOWLEDGE, THIS IS THE FIRST REPORTING OF SUCH FINDINGS OF ANY STUDY PERFORMED IN THE UK OR THE DEVELOPING WORLD.” The lead researcher, Dr Louise Brough, commented: “This research highlights the concerning fact that a number of women even in the developed world, are lacking in important nutrients during pregnancy. It also demonstrates the benefit of taking a multiple micronutrient supplement such as Pregnacare®. It is especially important to have good nutrient levels during early pregnancy as this is a critical time for development of the foetus. Pregnacare®, as used in the study, was shown to improve nnutrient ssttaattuussrrelative to placebo.” By the third trimester, mothers who took Pregnacare® w ere also found to have, relative to placebo, increased levels of iron, vitamin B1 and vitamin D3. Specially formulated by eexxppeertrs, Pregnacare® replaces a usual multivitamin and provides a careful balance of 19 essential vitamins and minerals. It includes the recommended 10mcg vitamin D and also 400mcg folic acid which contributes to maternal tissue growth during pregnancy. Plus iron which contributes to normal red blood cell formation and normal function of Originally developed with Conception Breast-feeding ‘Plus Dual Pack Original Prof. A. H. Beckett† QUEEN’S AWARD OBE, PhD, DSc (1920-2010) FOR ENTERPRISE IN Professor Emeritus, INNOVATION University of London * IN VITAMIN RESEARCH Important: some pregnancy formulas do not include the exact 10mcg vitamin D, as recommended by the Department of Health for all pregnant and breast-feeding women.ADPRGTRADEP02-08-13E Pregnacare® is the prenatal multivitamin brand midwives recommend most††, so you can recommend it with confidence. 1 L Brough, GA Rees, MA Crawford, RH Morton, EK Dorman (2010) Br J Nutr. 2010 Aug;104(3):437-45 † Professor Beckett is not cited in the capacity of a health professional, but as a product inventor and former Chairman of Vitabiotics. ††Based on a survey of 1000 midwives. For more information on this research, please visit www.pregnacare.com/mostrecommended * UK independent sales value data (IRI 52 w/e 20 Apr, 13) www.pregnacare.com

38 • Cochrane corner September 2013 • THE PRACTISING MIDWIFEand eosin) and/or topical application of The use of significantly increased cordantibiotics (such as bacitracin, chlorhexidine, separation time compared toneomycin, nitrofurazone or tetracycline) compared to dry cord salicylic powder. Povidone resulted(Zupan et al 2004; Imdad et al 2013). care, resulted in a 23 in a shorter cord separation time per cent reduction in compared to silver sulphadiazine.Methods infant death rates inStudies that reported on randomised community settings Washing cord versus dry cord carecontrolled trials, cluster-randomisedtrials and quasi-randomised controlled • Antiseptics significantly reduced • One large community trialtrials of topical cord care compared with omphalitis in community settings compared washing the umbilicalno topical care or comparisons of (up to 56 per cent). There was no cord with soap and water to drydifferent types of topical cord care were difference in the incidence of cord care; there was no differenceconsidered eligible for inclusion. omphalitis in hospital settings in infant death rates, omphalitis orParticipants were live newborns with or when antiseptics were compared in cord separation time betweenwithout risk factors for the with dry cord care. the groups.development of infection regardless ofplace of birth. Two review authors • The antiseptics chlorhexidine, • One hospital based studyindependently assessed each study for triple dye, silver sulphadiazine and examined colonisation rates ofinclusion in the review, assessed the risk fuschine significantly reduced staphylococcus aureus and foundof bias (quality assessment) in each bacterial colonisation in hospital no difference in rates between thestudy and independently extracted settings. When alcohol was used cord washing and the dry cord careeach study’s data using a pre-specified there was no difference between groups.form. A number of outcomes were of the groups.interest to the authors and these Implications for practiceincluded: infant death, sepsis, • Cord separation time was on Three large studies included in thisomphalitis, tetanus, bacterial colonisation average longer in the review were conducted in communityand time to cord separation. chlorhexidine group in the settings in low-income countries. In this community setting. In the hospital setting, the incidence of omphalitis isFindings setting, cord separation time was higher than in hospital settings. ThisThirty-four studies, involving 69,338 longer when alcohol was used. may reflect differing cultural andbabies, were included. Three of the traditional practices with respect tostudies were large, cluster-randomised Antiseptic versus antiseptic cord care after birth. In a survey of 349trials from community settings in low- mothers in Nigeria, for example, 61 perincome countries (Bangladesh, Pakistan • There was no difference in the cent applied methylated spirit to theand Nepal). The remaining 31 studies incidence of sepsis when cord stump, 25 per cent used hotwere from hospital-based settings, 26 chlorhexidine was compared to compress, 9 per cent appliedof which were conducted in high- salicylic acid powder toothpaste, 3 per cent applied herbsincome countries. The majority of and 2 per cent applied dusting powderstudies were of moderate quality. There • There was no difference in the (Mukhtar-Yola et al 2011). In a furtherwere 22 different treatments evaluated incidence of omphalitis when survey in Pakistan, substances such asacross the studies, with some studies alcohol was compared to triple coconut oil, ghee, turmeric, kohl andevaluating more than one treatment. dye, povidone, salicylic powder, talcum powder were used for cord careThe findings are presented by green clay powder, fuschine and (Ayaz and Saleem 2010). In this review,treatment groups: chlorhexidine. there is strong evidence for the use of chlorhexidine in community settings, inAntiseptic versus dry cord care • There was no difference in cord low-income countries. Although it may separation time when triple dye increase cord separation time, it • The use of chlorhexidine, compared was compared to alcohol or to significantly reduces neonatal death and to dry cord care, resulted in a 23 silver sulphadiazine. Chlorhexidine infection compared with dry cord care. per cent reduction in infant death rates in community settings. There Of the studies conducted in hospital were no data on infant death rates settings, compared with dry cord care, for hospital settings. there was no advantage to using antiseptics in preventing omphalitis. Although alcohol and triple dye reduced

THE PRACTISING MIDWIFE • September 2013 Cochrane corner • 39There is no convincing Comment Ireland J, Rennie AM, Hundley V et al (2000).evidence for antiseptic In hospital settings, in high and low ‘Cord-care practice in Scotland’. Midwifery,use in hospital settings income countries, dry cord care after 16: 237-245.compared with dry cord birth is recommended. In communitycare settings, in low-income countries, McKenna H and Johnson D (1977). ‘Bacteria in chlorhexidine to clean the cord after neonatal omphalitis’. Pathol, 9(2): 111-113.bacterial colonisation, there were no birth is recommended. TPMdata to show that this resulted in Mir F, Tikmani SS, Shakoor S et al (2011).decreased rates of sepsis or omphalitis. Valerie Smith is lecturer in midwifery and ‘Incidence and etiology of omphalitis inIn summary, there is no convincing post doctoral midwifery research fellow at Pakistan: a community-based cohort study’.evidence for antiseptic use in hospital Trinity College Dublin Jour Inf in Devel Countries, 5(12): 828-833.settings compared with dry cord care. Ina survey of Scottish practices, however, References Muckhtar-Yola M, Lliyasu Z and Wudil BJ (2011).variations in practices were found ‘Survey of umbilical cord care and separation(Ireland et al 2000). In this survey, 33 Ayaz A and Saleem S (2010). ‘Neonatal mortality time in healthy newborns in Kano’. Niger Jourper cent of staff reported a practice of and prevalence of practices for newborn care Paed, 38(4): 175-181.no specific care, 25 per cent reported in a squatter settlement of Karachi, Pakistan:water, 16 per cent alcohol and powder, a cross-sectional study’. PLoS One, 5(11): Mullany LC, Darmstadt GL, Katz J et al (2009).13 per cent alcohol and 13 per cent e13783. ‘Risk of mortality subsequent to umbilicalreported powder. cord infection among newborns of southern Imdad A, Bautista RMM, Senen KAA et al (2013). Nepal: cord infection and mortality’. Ped Inf ‘Umbilical cord antiseptics for preventing Dis Jour, 28(1): 17-20. sepsis and death among newborns”. Cochrane Database of Systematic Reviews NICE (2006). Routine postnatal care of women (CDSR), CD: 008635. and their babies, London: NICE. WHO (1999). Care of the umbilical cord: a review of the evidence. WHO maternal and newborn health safe motherhood, Geneva: WHO. Zupan J, Garner P and Omari AAA (2004). ‘Topical umbilical cord care at birth’. CSDR, 3: CD 001057.Professional development Ireland’s Annual Joint Midwifery Conference Possibilities Practices Patnership Crowne Plaza Hotel, Dublin Northwood, Santry, Dublin 9 - Thursday, 17th October 2013 Maternity Care - Everyone’s ͚DĂƚĞƌŶŝƚLJĂƌĞͲǀĞƌLJŽŶĞ͛ƐīĂŝƌ PoAlifcfaieirs WƌĂĐƟĐĞƐ͕WĂƌƚŶĞƌƐŚŝƉƐ͕WŽůŝĐŝĞƐĂŶĚWŽƐƐŝďŝůŝƟĞƐ͛Topics will include:t
Accessing Maternity Services t
Smoking Cessation Policiest
Primary Care Policy - Where is the Midwife? t
Perineal Caret
Cardiac Disease in Pregnancy t
Womens Voice in Driving Policyt
Documentation t
From policies to possibilities in practice - The Role and Challenge for Every Midwife Call For PostersPosters addressing the conference theme may be submitted by individual midwives, groups ofmidwives, midwifery students or service users. The title and overview of poster presentation (50-100 words) to be submitted by email by Friday 20th September 2013 To submit a poster: Please complete the application form (available at www.inmo.ie) and return by email to [email protected] tel: 01 6640616 *Only electronic submissions will be accepted*

International Journal of Birth and Parent EducationLaunch Conference, October 16th, 2013University of WorcesterSt John's Campus, Henwick Ave, Worcester WR2 6AJTime: 9:30-4:15Please contact: Naomi Rusher, Events Coordinator01905 855 147 or [email protected]

£1102-day delegate passincluAdwinadgridsescn!otPurlynutstsogatrvhoaeuiplNau&btlesrittuiodnen&tHealth 14TH NATIONAL CONFERENCE & EXPO Friday 1st & Saturday 2nd November 2013 London Olympia REGISTER ONLINE NOW! www.nutritionandhealth.co.uk NOT TO BE MISSED! The UK’s first & leading Conference, Expo & Awards for all professionals in nutrition & health Explore New & Consensus Scientific Research Results - Learn From Innovative & Evidence-Based Best Practice Case Studies - Discuss Dietary Advice & Behaviour Change - Engage & Network With More Than 600* Other Delegates:UK Nutrition Policy & Strategy in 2014 • Heart Health • Obesity & Weight Management • Gut Health, Allergies & Intolerances • Supplements & Fortification • Child Health • Nutrition & Ageing • Food Labelling • Commissioning Dietary Services • Food Taxation • and Much More! FOR MORE INFORMATION CALL +44 (0)20 8455 2126 OR EMAIL [email protected] *602 in 2012

42 September 2013 • THE PRACTISING MIDWIFELAST WORDPoetic licence Laura Griffin When it came to thinking about the introduction for my third year portfolio, 3rd year student midwife at I decided the best way to express my true feelings in a way which the reader Wolverhampton University could understand and enjoy was to write a poem. Learning to become a midwife is not easy: it is a journey,with life changing experiences; it comes with lows,but the highs outweigh these by far; it takes strength and encouragement and it has been much more than I expected it to be.I sit and reflect on days gone by times that were highOn the times that were low and the as a student are very immenseThe shifts and assignments I feel were intenseThe nightsMentors, placements, all to handleAnd a life size pelvis on my mantleMany times I felt I was fightingUp till all hours completing my writingFamily life can bring great stressBut support was there, I had the best understood the pressureFriends I made how to balance with leisureThey taught meMy job is the best one there ever could beMaking a difference to one’s familyPassion lies within people like meFor empowerment, support to make them feel freeHer knees are hurting so I offer a cushionShe bears down and she’s ready for pushingMy job is to be there to empower her throughWiping her fears and her brow tooI watch as she births her baby boyWhen the tears of pain turn to those of joyAnd when I look back to all that I’ve hadThe best of all outweighs the bad

NOW ONLINEwww.ingentaconnect.com/content/mesl/tpmTHE BEST JOB IN THE WORLDwww.thepractisingmidwife.com Volume 16 no 8 • September 2013 The most comprehensive collection of academicEducation and professional publications online, Using simulation in comPlsuptuhslepeFmprRalEeepEnmieteasnryt midwifery education with more than 5 million articles available The role of mentors in the evaluation of learning Narrative pedagogy A new approach to reflectionPersonal subscribers Institutional administrators• Register free at • Register free atwww.ingentaconnect.com/register/personal www.ingentaconnect.com/register/institutional• Following registration, select Personal • Following registration, select Set upsubscriptions subscriptions• Select the The Practising Midwife and • Select the The Practising Midwife and enterenter your subscription number your subscription number• You will be notified by email once your • You will be notified by email once your onlineonline access has been activated access has been activatedPlus, take advantage of extra free services available on ingentaconnect, including upto five New Issue Alerts, RSS feeds, marked lists, social bookmarking, and more.

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