From social to surgical: historical perspectives on perineal care during labour and birth

A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98–138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention – most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.     

Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention ‘bundle of care’

Background‘Bundles of care’ are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers.ObjectiveTo gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention.MethodsA 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation.Results227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations “all the time” for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices.ConclusionsAreas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.     

Getting Off: Development of a Model Program for Gay and Bisexual Male Methamphetamine Users

An evidence-based gay-specific cognitive behavioral therapy (GCBT) intervention for methamphetamine-using gay and bisexual men was adapted for use in a community-based setting, thereby moving research into practice. The 48-session, 16-week GCBT intervention was revised to 24 sessions requiring 8 weeks and renamed Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users. GCBT was modified for implementation within the limited resources and capacity of community-based organizations while also retaining drug use and HIV risk reduction outcomes. Since 2007, Getting Off has been sustained with public health funding at the community site and has been adopted by multiple community-based sites.     

Queering marriage: an ideographic interrogation of heteronormative subjectivity

Recent debates on same-sex marriage mark the institution, practice, and concept of marriage as a significant site of power and resistance within American culture. Adopting Michel Foucault's conception of "discipline," this essay examines how marriage discourse reinforces heteronormative power relations through its rhetorical constitution of gay male identity. Supplementing "ideographic" critique with Judith Butler's theory of performative speech acts enables us to better interrogate and resist these operations of power. This essay maps the contemporary scene of heteronormative power and resistance through two rhetorical performances of gay male identity. The marriage debates, in the first instance, demonstrate how a conventional desire for masculine agency influences the heteronormative production of gay male identity. In the second instance, gay male SM [sadomasochism] performs a concept of "relational agency," which potentially resists heteronormativity.     

Social Work with the Osteoporotic Woman

A chronic, progressive, and potentially debilitating condition, osteoporosis has a multitude of currently untapped implications for effective social work practice. A working knowledge of the medical framework of the disease process itself is a prerequisite to informed practice. This article presents such information, along with the psychological and social components, in order to provide the social worker with the comprehensive biopsyehosaial knowledge base necessary for effective practice with the osteoporotic woman and her family.     

Physical Self-Efficacy and Depressive Symptomatology in Older Women: A Group Treatment Approach

This article presents an outline of a practice model geared toward alleviating depressive symptomatology in older women. Based in Bandura's (1977) self-efficacy theory, and on empirical data reported in this article, the focus of the practice model is on physical self-efficacy as a cognitive mediator of depressive symptoms in older women. Through the use of a group treatment approach, an attempt is made to raise levels of physical self-efficacy, and to determine the concomitant changes in depressive symptoms. Finally, the importance of continued research, and the further refinement of practice methods based in theory is stressed.     

The spread of anti-natal knowledge and practice in Nigeria

Abstract In March/April 1969 the Demographic Training and Research Unit, University of Ife, surveyed 8,400 respondents of both sexes to investigate their knowledge and use of anti-natal practices and the sources of that knowledge. The area sampled was a stratified cross-section of Nigeria extending inland 500 miles from Lagos. Data are analysed by age cohorts of respondents and by the date of change in knowledge or practice. It is shown that anti-natal knowledge and practice decline with distance from Lagos, that contraception is widely practised amongst the richer towns and those with a higher proportion of educated people, and to a smaller extent among farmers than restricted knowledge or means would alone indicate. Recently the spread of both knowledge and practice has been faster than could be explained by socio-economic change and has largely resulted from changing attitudes to anti-natal practice and increased discussion of the subject in the world as a whole. Within Nigeria this has been helped by rising levels of urbanization and education, which are the two major determinants of anti-natal knowledge and practice in the country. The spread of such practice has led to an increased employment of traditional anti-natal methods, but this increase is small compared with the much greater resort now being made to modern contraception and induced abortion. The mass media have been of particular importance in introducing new knowledge, while the spread of such knowledge has owed most to discussions between friends of the same sex.     

Jography: Exploring Meanings,Experiences and Spatialities of Recreational Road-running

Jogging is a relatively under-researched mobile practice with much existing literature focusing on ‘serious’ and competitive running. In this paper, we provide an account of some of the movements, meanings and experiences that together help produce the practice of jogging in the south-western English city of Plymouth. Drawing upon participant diaries and interviews, we uncover rich detail about how joggers ascribe not one but a number of meanings to their practice. Some of these are positive, some are negative; some complement each other and some compete with each other. We also consider how the experiences of joggers can be shaped by their ongoing need to develop tactics capable of enabling them to negotiate space with non-joggers. This is in some contrast to more competitive running that occurs in the separated space of an athletics track. Our sense is that better awareness of the meanings and experiences of jogging will be of value if the advertised health and sustainability benefits of the practice are to be more effectively encouraged and promoted.     

Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States

Background

Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US.

LGBT Family Lawyers and Same-Sex Marriage Recognition: How Legal Change Shapes Professional Identity and Practice

ABSTRACT

Lawyers who practice family law for LGBT clients are key players in the tenuous and evolving legal environment surrounding same-sex marriage recognition. Building on prior research on factors shaping the professional identities of lawyers generally, and activist lawyers specifically, I examine how practice within a rapidly changing, patchwork legal environment shapes professional identity for this group of lawyers. I draw on interviews with 21 LGBT family lawyers to analyze how the unique features of LGBT family law shape their professional identities and practice, as well as their predictions about the development of the practice in a post-Obergefell world. Findings reveal that the professional identities and practice of LGBT family lawyers are shaped by uncertainty, characteristics of activist lawyering, community membership, and community service. Individual motivations and institutional forces work to generate a professional identity that is resilient and dynamic, characterized by skepticism and distrust coupled with flexibility and creativity. These features are likely to play a role in the evolution of the LGBT family lawyer professional identity post-marriage equality.     

The return of weighing in pregnancy: A discussion of evidence and practice

BackgroundInadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight management strategy for addressing gestational weight gain.DiscussionThe effectiveness of routine maternal weighing as part of maternity care has been debated for more than 30 years. The National Health and Medical Research Council of Australia have recently revised their pregnancy care clinical practice guidelines recommending maternal weight monitoring (clinician and/or self-weighing) be reintroduced into clinical practice. This paper presents a timely discussion of the topic that will contribute new insights to the debate.ConclusionWeight gain in pregnancy is complex. Evaluation of the translation, implementation, acceptability and uptake of the newly revised guidelines is warranted, given that evidence on the practice remains inconclusive. Future research exploring social ecological interventions to assist pregnant women achieve optimal gestational weight gains are suggested to expand the evidence base.     

Space,place and the midwife: Exploring the relationship between the birth environment,neurobiology and midwifery practice

BackgroundResearch indicates that midwives and their practice are influenced by space and place and that midwives practice differently in different places. It is possible that one mechanism through which space and place influence midwifery practice is via neurobiological responses such as the production and release of oxytocin, which can be triggered by experiences and perceptions of the physical environment.AimTo articulate the significance of space and place to midwifery and explore the relationship between the birth environment, neurobiology and midwifery practice.DiscussionQuality midwifery care requires the facilitation of trusting social relationships and the provision of emotionally sensitive care to childbearing women. The neuropeptide oxytocin plays a critical role in human social and emotional behaviour by increasing trust, reducing stress and heightening empathy, reciprocity and generosity.Principle conclusionThrough its role as a trigger for oxytocin release, the birth environment may play a direct role in the provision of quality midwifery care.     

International consensus definition of critical thinking in midwifery practice: A Delphi study

ProblemCurrently there is no discipline-specific definition of critical thinking in midwifery practice.BackgroundCritical thinking in midwifery practice is the cornerstone for safe, evidence based, and woman centred clinical decision-making. Available definitions of critical thinking in other disciplines do not align with midwifery practice which is distinctive, multidimensional and complex.AimTo develop an international consensus definition of critical thinking in midwifery practice.MethodsA two round Delphi study was used. Thirty-two international midwifery experts contributed to the first round which was qualitative in nature. Twenty one of these experts then ranked the relevance and clarity of concepts from round one.FindingsA consensus definition of critical thinking in midwifery practice was achieved. The expert panel identified and defined 14 ‘Habits of Mind’ and 12 Skills that are the core of critical thinking in midwifery practice. Skills included; analysis, constructive application and contextualisation of best available evidence, problem solving, discriminating, predicting, evaluation of care, collect and interpret clinical cues, collaboration/ negotiation, reflexivity, facilitates shared decision-making, communication, and transforming knowledge. Habits of Mind included; intellectual curiosity, reflective, holistic view, intellectual integrity, flexibility, questioning/challenging, participatory, open mindedness, listening with understanding and empathy, cultural humility, woman centred, being brave, confidence, and creativity.Discussion/conclusionThis study is an international first and delineates characteristics of critical thinking in midwifery. Development of a consensus definition provides a common and shared understanding of the skills and attributes required for critical thinking in midwifery practice and can also be applied in education and research.     

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system

BackgroundThe Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as ‘baby friendly’. This variance has persisted regardless of BFHI implementation in Australia gaining ‘in principle’ support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices.AimIdentify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia.ResultsKnowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia.ConclusionAustralian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included.     

Regulating The Abject

In this paper, through an examination of mostly British make-over television programs we examine how the feminine has become a new site of limitless possibility and endless consumption, the fulcrum of intensifying processes of neo-liberal reinvention of continuously making over the self into successful, post-feminist bourgeois subjects. We argue that the central premise of contemporary make-over programs is the question: “Is the transformation of abject subjects possible?” We also suggest the focal object of transformation in many shows is the working class woman who fails both as subject/object of self-reflexivity, desire, and consumption. We argue it is her mind and body that represents a core site of abjection—a subjectivity designated as uninhabitable and therefore also a central site of regulation. It is upon the working class woman's mind and body that the drama of possibility and limitation of neo-liberal reinvention is played out. We also argue that it is perhaps in reference to that which is made abject and uninhabitable that it becomes possible to talk about class as a dynamic of identifying against what we must not be, and which fuels incessant attempts to refashion selves into generalized and normalized bourgeois feminine subjects.     

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

BackgroundPreeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed.AimThis study focuses on the midwife’s role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines.Method/designThis study was a qualitative document analysis of national and tertiary hospital policies related to midwives’ scope of practice in Ghana. Altheide’s five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents.ResultsThe findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia.ConclusionUniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives’ roles, and optimise maternal and fetal outcomes.     

A new method to control houseflies,Musca domestica, at waste disposal sites

Summary Investigation was carried out from 1976 to 1979 to establish a new control system against the houseflies,Musca domestica, at a sea-filling waste disposal site in Osaka Bay, Japan. Field surveys showed that the garbage was favorble for the fly breeding for 20–30 days after being disposed, while the sewage sludge and the ash from incinerated refuse were unfavorable. Comparing the fly density at the site to the reported cases of the public complaints in the urban area near to the site, a complaint threshold density of the flies at the site was estimated. Then, a control threshold density was assumed from the complaint threshold density and the reproductive rate of the housefly population. Several insecticides, as well as a surface active agent, polyoxyethylene lauryl ether (PEL), were found effective for the temporary suppression of the fly density. Based on the results obtained, the following control system was worked out. 1) Refuse is disposed onto the same area as other inorganic wastes to deteriorate the capacity of breeding sources. 2) The fly density is examined on newly disposed refuse almost everyday by landfill operators. 3) PEL is sprayed when the density slightly exceeds the control threshold density. If the density increases rather higher, insecticide should be used. 4) The disposed refuse is covered with soil or other inorganic wastes on every weekend or every other weekend by 15 cm thickness. Success in both fly control and reduction of the amounts of insecticides sprayed was achieved by a field application of this new control system.     

Family planning practice and women's fertility decision-making power

This paper investigates the effects of family planning practice on fertility decision-making power in South Korea. The log-linear analysis of the 1981 survey data by the Institute of Population and Health Services Research, Yonsei University, Seoul, Korea, shows that those urban and rural women who practice family planning or have experienced abortion exercise greater influence on a couple's fertility decision making than those who do not practice family planning or who have had no abortion experience. In addition, there is the interactive effect of abortion experience and contraceptive use on fertility decision making among urban women. This finding is significant because regardless of how birth control is available within a society, birth control use enhances women's decision making power where fertility is concerned.     

Subversive acts and everyday midwifery: Feminism in content and context

BackgroundMidwives are often at the forefront of political campaigns for women's empowerment, overtly advocating for women's rights and reproductive justice. However, midwives can also be found engaging in inadvertent activism on a daily basis within routine care. When casting a feminist lens over both the content and context of midwifery practice in Australia, subversive acts and opportunities for feminist reform can be found.AimTo interrogate the significance of feminism in midwifery practice, identifying feminist successes and further opportunities for implementation including: analysis of the Midwifery Standards for Practice; the primary tenets of woman-centred care; the content versus context of midwifery in Australia; and feminist opportunities for enhanced practice. This paper will discuss the importance of feminism in midwifery practice and its significance in informing optimal midwifery care.DiscussionIncorporating women's voice and respecting women's bodies and agency in the delivery of care is a fundamental component of midwifery practice. However, while the content of midwifery practice is innately feminist in its emphasis on woman-centred care, it will be argued that the context of birthing in Australia is not. The resultant effect is the emergence of victim blaming in maternity care and the construction of an archetypal ‘good birthing woman’.Implications and recommendationsMoving away from the myth of the ‘good birthing woman’ and the act of victim blaming, midwifery could instead direct its focus towards challenging the rigid systems and structures within which midwives implement care. By further embracing feminist principles midwives will ensure a truly woman-centred future.