Midwifery Literature Research Articles

THE INFLUENCE OF MARMET TECHNIQUE ON ASI PRODUCTION IN POST PARTUM MOTHERS

Breast milk is the best and most ideal food for babies, because breast milk contains all the nutrients needed in the right amount and balance. In addition, breast milk contains immune substances or antibodies that function to protect infants from various germs so that they can prevent various diseases that are at risk of increASIng morbidity and mortality in infants. However, until now there are still many babies who do not get breast milk on the first day of birth, this causes many nutritional problems for babies in Indonesia to occur, one of which is insufficient nutrition in infants. This research is a quantitative method using a quASI-experimental method. This study aims to determine whether there is an effect of the Marmet Technique on Breast Milk Production in Postpartum Mothers at the Village Health Post of Simpang Bayat Bayung Lencir in 2023. This research was conducted in March-June 2023. The population in this study were all post partum mothers 1-7 days at the Simpang Bayat Poskesdes totaling 24 post partum mothers. The sample of this research is 20 people. The technique used is Accidental Sampling. This research uses univariate and bivariate analysis. Based on the results of the study, it was shown that there was an increase in milk production using the guinea pig technique and data analysis obtained p value = 0.000 (α < 0.05) so that there was an influence between the guinea pig technique and breast milk production. It is hoped that the results of this study can provide additional knowledge for health workers in providing care for breastfeeding mothers in increASIng breast milk production, as well as for midwifery education can add to midwifery literature so that they can provide broader insights on maternity, especially regarding how to expel breast milk

The role of motivation in the initiation and maintening mentoring relationships among nurses and midwives.

To understand clinicians' motivations to engage in mentoring to support newly graduated nurses and midwives working in hospital settings. Nursing and midwifery literature has established the benefits of mentoring and challenges that affect the effectiveness of formal mentoring programmes. No studies have explored hospital nurses' and midwives' motivations to mentor in the absence of the obligatory status and associated rewards of institutionalised mentoring. A qualitative descriptive study with 35 nurses and midwives working in three public hospitals in the western, northern and northwestern parts of Uganda. Data were collected using semistructured interviews. Reflexive thematic analysis was applied to interpret the data. We have adhered to COREQ reporting guidelines. The study revealed three salient themes that capture nursing and midwifery professionals' mentoring perspectives. Participants expressed confidence in their inherent mentoring capacities and were often motivated by a desire to reciprocate prior mentoring experiences. Their mentoring approaches varied between self-focused and other-focused motivations, with some overlap in perspectives on hierarchical versus relational mentoring. Across the board, there was a strong consensus on the need of mentoring for individual clinicians, healthcare institutions and the broader profession. The study highlights five opportunities that can be harnessed to design future mentoring programmes. The findings delineate a complex interplay between self-centred and altruistic mentoring motivations, aligning with hierarchical or mutually beneficial mentoring paradigms. Nurse managers should tailor mentoring programmes to align with these intrinsic motivations, affirm the enduring need for mentoring, and leverage existing institutional resources to create both acceptable and efficient mentoring frameworks.

Global mental health experiences of single mothers: A mixed methods research synthesis.

The aim of this research is to synthesize findings from primary studies (quantitative and qualitative) that investigated the global mental health experiences of single mothers to provide a deeper understanding to better care and respond to the support needs of single mothers. Hayvaert et al.'s mixed methods research synthesis approach. The search process in the following databases, CINAHL, PsycINFO, and Scopus resulted in eight high-quality studies (5 qualitative and 3 quantitative) published between June 2016 and July 2021. Descriptive statistics and instrument scores were provided in summary form. Themes were analysed using Krippendorff's content analysis. A joint display was provided to reveal a complementary relationship between two different data sets. A total of 348 single mothers participated. Amongst the pooled sample, women identified as: Japanese (n=174), Israeli (n=147), Black African (n=18), African American (n=9), Native American (n=5), Burundian-Australian (n=8), UK British (n=12), Asian (n=3), South Korean (n=7), Indian (n=2), Malaysian (n=44), Hispanic/Latina (n=1) and Eastern European (n=3). Four themes were identified: (1) Learning to let go of the past, (2) It takes a whole village: Importance of social support, (3) Seeking a self-reliant life: Challenges with balancing career & childcare and (4) Finding strength within: Personal growth. Only one intervention utilizing creative group counselling was found to significantly decrease depression (p=.008), anxiety (p=.005), and stress (p=.012) whilst increasing self-compassion (p=.013). It is important for clinicians who care for single mothers, particularly if they recently immigrated, are multiparous, and an ethnic minority to encourage engagement in peer-initiated counselling and obtain mental health care as necessary. This study identified and addressed the mental health issues that single mothers face worldwide. This is also the first mixed methods research synthesis to report single mothers' ethnicity in nursing and midwifery literature. Thus, findings from this mixed methods research synthesis can help nurses worldwide build culturally-concordant programs in their respective community organizations and partners (e.g. community health centres, mother-child enrichment clubs), inform health policies, and promote safer spaces for many single mothers, particularly for those who will immigrate to the Global North (i.e. UK, US, Canada) and become an ethnic minority.

Visual Analysis of Midwifery Research in China Based on Bibliometrics.

This study used bibliometrics to analyze the current trends, hotspots, and frontiers in Chinese midwifery research. A search was conducted among midwifery literature published from 2010 to 2020, and bibliometric and information visualization analyses were conducted using the acquired data. A bibliometric analysis was performed on the quantity and trends in midwifery research, distribution of and cooperation among research institutions, coauthorship, distribution of disciplines, high-frequency keywords, and burst terms. Cooperation mode, research hotspots, and research frontiers were also analyzed. The findings indicate that the number of midwifery research studies have been steadily increasing in China over the last decade. During the study period, Guangdong Province, which received the most research funding, produced the highest number of published articles, followed by Beijing and Shanghai. Research institutions related to midwifery are mainly universities with a strong focus on scientific research. Contemporary topics include core competencies and birth outcomes; research frontiers, including education; competence; and evidence-based practice. China should accelerate in-depth midwifery research; increase opportunities for regional, institutional, and team cooperation; promote the sublimation of midwifery work from practical experience to disciplinary theory; and provide higher-quality professional services for maternal and child health. Bibliometric analyses may be used to examine midwifery research in other countries too.

The contractile effects of various species of the Angelica genus on isolated uterine tissue of Mus musculus

Herbal preparations have been utilized in midwifery to facilitate the birthing process. Nevertheless, these preparations are not under the scrutiny of the Food and Drug Administration, and there is a lack of clinical trials to demonstrate their safety and effectiveness. The Angelica genus, including dong quai (Angelica sinensis), Angelica archangelica, and Angelica sylvestris, has been used by midwives to induce uterine contractions. The primary goal of this project was to investigate midwifery claims by measuring the contractile effects of A. sinensis, A. archangelica, and A. sylvestris on isolated Mus musculus uterine horns. All Angelica species, when tested at similar concentrations, produced contractile forces greater than that of the tissue's own spontaneous motility. Of the Angelica species, dong quai yielded the greatest contractile force. In addition, A. archangelica demonstrated concentration dependency when producing contractile forces. The results herein support that the Angelica species reported in midwifery literature do indeed induce contractions at the reduced level of isolated tissues. Future research that would demonstrate the absorption and distribution of the herbal constituents following oral consumption would lend more support to the use of these herbals at the organismal level.

Is the Concept of Midwifery Abdication Evident in Australian Case Law? A Systematic Review of Legal Literature, Court/Tribunal Decisions, and Coronial Findings

BACKGROUNDThis review builds upon previous work exploring the concept of Midwifery Abdication, within the national midwifery literature. This article focuses on Australian legal literature, court/tribunal decisions and coronial or coroner's court findings.OBJECTIVETo explore Midwifery Abdication and whether it is evident within Australian caselaw.DATA SOURCESAustralian Legal literature, coronial findings, and court/tribunal decisions reported by the Australian Health Practitioner Regulation Agency, during 2005–2020.ELIGIBILITY CRITERIA1,246 cases were located using the presented search terms. Use of exclusion criteria resulted in the inclusion of 41 cases.METHODSWhile there are no validated tools to appraise caselaw, this review followed a robust protocol that guides the preparation and reporting of systematic reviews. Midwifery Abdication was identified using previously validated, interrelated constructs.RESULTSMidwifery Abdication occurred in 41 cases; that included one or more previously identified constructs. In line with the associated integrative review, a midwife's professional identity, environmental hierarchy and associated culture of social obedience are all shown to act as influencing factors in Midwifery Abdication.LIMITATIONSRigorous and reproducible processes were used; however, limited search functionality of some data sources may have resulted in inadvertent omission of cases. While this review relates to case law in one high-income country it provides a platform for further international research.CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGSAcknowledging Midwifery Abdication in Australian caselaw may serve to strengthen the midwifery voice and encourage an enhanced educational and reflective focus on midwifery philosophy and decision-making. Midwifery education must empower midwives to embrace their autonomous status while enhancing their abilities to optimize informed decision-making within a woman-centered midwifery philosophy.

The use of continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies: A survey of Australian and New Zealand hospitals

ObjectiveFreedom of movement and choice of positioning in labour and birth is known to enhance physiological processes and positive experiences for women during childbirth. Continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies, such as wireless CTG, have been marketed for clinical use in most high resource settings since 2003 but there is a paucity of midwifery literature about its clinical use. The aim of this survey was to determine how often, and for whom, wireless and beltless technologies are being used in maternity settings across Australia and New Zealand and to identify any barriers to their uptake. DesignA survey tool developed by Watson et al. (2018) for use in the United Kingdom was adapted for the Australian/New Zealand context. One Maternity Unit Manager or key midwifery clinician from each of 208 public and private hospitals across Australia and New Zealand was invited by email to participate in an online survey between October 2019 and January 2020. Descriptive statistics were used to describe the characteristics of the facilities and the frequency of availability of the monitors. Free text responses were thematically analysed. FindingsThe survey received a high (71%) response rate from a range of public and private hospitals in urban and rural settings. Women's freedom of movement and sense of choice and control in labour were seen by most respondents to be positively influenced by wireless monitoring technology. Most facilities reported having at least one wireless or beltless foetal monitor available, however, results suggest that many women consenting to continuous monitoring still do not have access to technology that enables freedom of movement. KeyconclusionsFurther research is required to explore the barriers and facilitators to enabling freedom of movement and positioning to all women in childbirth, including those women with complex pregnancies who may consent to continuous foetal monitoring.

Australian midwives and clinical investigation: Exploration of the personal and professional impact

BackgroundThe purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction. AimTo explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives. MethodSemi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty. FindingsTwelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had misconduct allegations. Midwives were employed or in private practice and half provided homebirth services. Themes included being safe, being connected, time and being, perception and well-being. DiscussionThe investigative process involves different health services, state and national bodies using varying powers and processes over protracted time periods. Participants discussed aspects such as disrespect, inequity, powerlessness, silence and ostracization. Midwives who successfully navigated clinical investigation developed resilience through reflection on clinical practice in a culture of safety. ConclusionThe process of regulating midwives, designed to protect the Australian public, may be harming investigated midwives. Understanding the personal and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.

Nursing and Sustainable Development Goals (SDGs) in a COVID-19 world: The state of the science and a call for nursing to lead.

The World Health Organization declared 2020 the Year of the Nurse and the Midwife well before the world was plunged into a pandemic response to SARS-CoV-2 (COVID-19). Worldwide, nurses are advancing critical research and policy efforts to achieve all 17 of the United Nations Sustainable Development Goals (SDGs). Nursing is best positioned to ask and answer how to achieve the SDGs over the next decade, and in this COVID-19 era. In this article, we summarize the state of the nursing and midwifery literature about the SDGs. Twenty-four publications met criteria for inclusion, with nearly half published in 2019. Findings emphasize a need for: (a) nursing curricula and training revisions to include SDG content and strengthen development of a future nursing workforce comprised of global citizens; (b) innovative and disruptive nursing research documenting advances toward achieving the SDG 2030 agenda; (c) nursing practice that operates within a SDG framework; and (d) responsive and proactive nursing policy development that foresees what is needed to achieve the SDGs. When the urgency of COVID-19 response subsides, the world will adjust to a new normal and nursing must be positioned to lead and contribute to micro- and macro-level efforts toward achieving the SDGs.

What disasters can reveal about techno-medical birth: Japanese women’s stories of childbirth during the 11 March, 2011 earthquake

Social researchers of childbirth have argued that techno-medical routines of managing childbirth risk are underpinned by worst case scenarios involving disastrous deliveries, with catastrophic consequences for maternal and neonatal health and life. This article looks into childbirth stories that ended safely amidst serious ruptures in techno-medical surveillance. We draw on the childbirth stories of women who gave birth during the 11 March 2011 disasters recorded by the first author in February 2016 and on an array of childbirth stories published in a journalistic book in 2012. The stories reveal the navigations of women and care providers between two different types of risks: risks associated with birth in the techno-medicalised model of care and risks associated with earthquakes. Underlying the safety management imperatives of each are divergent space and time lines. Significantly, the techno-medical surveillance of risk associated with childbirth proved to be secondary to the earthquake risk. Rather than high technologies, it was low-tech necessities and human care that proved crucial for the management of safe births. Though women interpreted the safe conclusion of their birth as miracle, their stories suggest that childbirth, especially when attended by skilled birth attendants, can take place relatively safely, even in the direst of conditions. Accounts of childbirth in the midst of disasters offer evidence and important insights in developing a critique of technological birth in the social scientific and midwifery literature.

Midwifery Abdication – is it acknowledged or discussed within the midwifery literature (Integrative Review)?

Midwifery Abdication – is it acknowledged or discussed within the midwifery literature (Integrative Review)?

Nurturing yourself and each other: The value of emotional intelligence

Background: Emotional intelligence refers to the individual's capacity to identify, use, understand and respond appropriately to emotions in themselves and others. The nursing and midwifery literature recommends emotional intelligence as an important construct for enhancing well-being amongst nurses and midwives. Despite this, how nursing and midwifery students perceive emotional intelligence is not well understood. Emotional intelligence capabilities are seen as fundamental to the student nurse or midwifes ability to negotiate the emotional complexities of clinical practice as well as support their own emotional well-being. Objective: The study aimed to explore final year undergraduate nursing and midwifery students' perceptions of emotional intelligence. Method: Qualitative data were collected via face to face semi-structured interviews with final year Bachelor of Nursing and Bachelor of Nursing and Bachelor of Midwifery enrolled at Deakin University, Victoria. Interviews were digitally recorded with participants' written and informed consent and professionally transcribed. Data was analysed using thematic analysis. Key Findings: Emotional intelligence was valued as an important concept, yet the application of emotional intelligence to their undergraduate curriculum was not well-defined. Participants appeared to be caught between competing paradigms; their perceptions of emotional intelligence and the reality of the clinical environment. Participants acknowledged the emotional aspects of their classroom and clinical learning, but were ill equipped and/or were not supported in linking their coping strategies to emotional intelligence. Suppression or denial of emotions, or distancing themselves behind tasks and policies were some of the strategies employed by participants in their attempt to impose emotional control within the clinical environment. Conclusion: Explicitly nurturing emotional intelligence in their undergraduate years would convey to nursing and midwifery students the importance of emotional well-being and may better equip them to manage the emotional complexities of their professional life.

Midwifery abdication - is it acknowledged or discussed within the midwifery literature: An integrative review.

INTRODUCTIONIn this review we explore the concept of Midwifery Abdication and whether it is acknowledged or discussed within the midwifery literature.METHODSA modified Whittemore and Knafl integrative review framework of 2005 enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of Midwifery Abdication. Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality.RESULTSMidwifery Abdication occurs, as reported within the wider midwifery literature, and indicated in three studies from different countries. However, the original constructs need to be widened to include: ‘external perceptions of midwifery practice’ and ‘how can reflection facilitate change’. The extent of philosophy in these environments leads to the adoption of midwifery philosophy failure. Such an environment impacts on a midwife’s ability to fully exercise autonomy, and to advocate for normality and women. This renders Midwifery Abdication almost inevitable or at least very difficult to prevent. A midwife’s professional identity, environmental hierarchy and associated culture of social obedience, acceptance and finding one’s place, all act as influencing factors in abdication.CONCLUSIONSMidwifery education needs to ensure that midwives are prepared and able to embrace their professional status as independent practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife’s professional autonomy and scope of practice reinforce the technocratic work environment.

The Five Attributes of a Supportive Midwifery Practice Climate: A Review of the Literature.

A supportive work climate is associated with decreased burnout and attrition, and increased job satisfaction and employee health. A review of the literature was conducted in order to determine the unique attributes of a supportive practice climate for midwives. The midwifery literature was reviewed and synthesized using concept analysis technique guided by literature from related professions. The search was conducted primarily in PubMed, CINAHL, Web of Science, and Google Scholar. Articles were included if they were conducted between 2006 and 2016 and addressed perceptions of the midwifery practice climate as it related to patient, provider, and organizational outcomes. The literature identified 5 attributes consistent with a supportive midwifery practice climate: effective leadership, adequate resources, collaboration, control of one's work, and support of the midwifery model of care. Effective leadership styles include situational and transformational, and 9 traits of effective leaders are specified. Resources consist of time, personnel, supplies, and equipment. Collaboration encompasses relationships with all members of the health care team, including midwives inside and outside of one's practice. Additionally, the patients are considered collaborating members of the team. Characteristics of effective collaboration include a shared vision, role clarity, and respectful communication. Support for the midwifery model of care includes value congruence, developing relationships with women, and providing high-quality care. The attributes of a supportive midwifery practice climate are generally consistent with theoretical models of supportive practice climates of advanced practice nurses and physicians, with the exception of a more inclusive definition of collaboration and support of the midwifery model of care. The proposed Midwifery Practice Climate Model can guide instrument development, determining relationships between the attributes of the practice climate and outcomes, and creating interventions to improve the practice climate, workforce stability, and patient outcomes.

The Spiritual Journey of Infertile Couples: Discussing the Opportunity for Spiritual Care

Infertility is a worldwide public health issue that exerts an in-depth impact on couples, families, communities and the individual. This reproductive health condition, along with fertility treatments, often forces couples to question their purpose and meaning in life, and to begin a spiritual journey. Nursing and midwifery literature describes the care of those living with infertility, but often lacks a clear approach of the spiritual dimension, and diagnosis and interventions may not be effectively addressed. In this paper, we present a discussion about spirituality and the assessment of spiritual needs such as hope, beliefs, meaning and satisfaction in life. In addition, spiritual needs are defined, for both nurses and midwives, and spiritual interventions are proposed for promoting couples’ resilience and spiritual well-being. Spirituality should be considered from the beginning to the end of life. It is necessary to translate this into the development and implementation of both specific policies regarding a spiritual approach and advanced education and training programs for nurses and midwives who care for infertile couples.

Unconscious collusion: An interpretative phenomenological analysis of the maternity care experiences of women with obesity (BMI≥30 kg/m²)

Backgroundobstetric and midwifery literature continually emphasise incidence and consequence of obesity in pregnancy. However, they offer less consensus on how best to support women who are obese. Therefore, this study explores in depth the lived experience of women who have a Body Mass Index (BMI) ≥30kg/m². This exploration provides a bio-psycho-social understanding of the lived experience of women to identify how best to support them throughout their childbirth experience. Methodsan Interpretative Phenomenological Analysis (IPA) design was adopted for this qualitative study. Purposive sampling of participants was conducted on the postnatal wards of a maternity hospital in the Republic of Ireland. In total, 15 participants volunteered to take part in semi-structured interviews conducted at six to ten weeks postnatally. Data were analysed utilising the IPA framework. Findingsthe results indicate that participants were conscious of the problematics of communicating obesity in pregnancy. The narrative data revealed an unconscious collusion between healthcare professionals and women as they navigate obesity related conversations. The behaviours related to unconscious collusion are incorporated in the sub-ordinate themes; ‘just recorded and that's all’, ‘but what's eating healthy? ‘pussy footing around’ and ‘I hate that word obesity. Conclusions and implications for practicethe findings highlight a lack of information received by participants from healthcare professionals regarding increased BMI or weight management. The data suggests that healthcare professionals appeared to collude with women to avoid challenging discussions regarding obesity. This may be related to avoidance on participants’ part and/or may be linked with healthcare professionals’ reluctance to communicate issues relating to increased BMI. Although participants were generally unhappy with the communication skills of health professionals, they readily acknowledged the sensitive nature of obesity related communications. The findings provide healthcare professionals with an important insight into issues of effective communication and obesity related healthcare promotion from the woman's perspective in order to enhance provision of appropriate health information and maternity care to women who have an increased BMI.

Leadership and emotional intelligence in nursing and midwifery education and practice: a discussion paper

A discussion of the concepts of leadership and emotional intelligence in nursing and midwifery education and practice. The need for emotionally intelligent leadership in the health professions is acknowledged internationally throughout the nursing and midwifery literature. The concepts of emotional intelligence and emotional-social intelligence have emerged as important factors for effective leadership in the healthcare professions and require further exploration and discussion. This paper will explore these concepts and discuss their importance in the healthcare setting with reference to current practices in the UK, Ireland and internationally. Discussion paper. A search of published evidence from 1990-2015 using key words (as outlined below) was undertaken from which relevant sources were selected to build an informed discussion. Fostering emotionally intelligent leadership in nursing and midwifery supports the provision of high quality and compassionate care. Globally, leadership has important implications for all stakeholders in the healthcare professions with responsibility for maintaining high standards of care. This includes all grades of nurses and midwives, students entering the professions, managerial staff, academics and policy makers. This paper discusses the conceptual models of leadership and emotional intelligence and demonstrates an important link between the two. Further robust studies are required for ongoing evaluation of the different models of emotional intelligence and their link with effective leadership behaviour in the healthcare field internationally. This is of particular significance for professional undergraduate education to promote ongoing compassionate, safe and high quality standards of care.

Clinical nursing and midwifery research in Middle Eastern and North African Countries: A Scoping Review

The professions of nursing and midwifery currently face many challenges, such as an increasing number of patients with communicable and non-communicable diseases, which strains resources and requires nurses and midwives to develop their knowledge and skills to a higher level. This is also true in the Middle East, including the Mediterranean East and North African regions, which means it is vitally important that nurses and midwives have access to and use current research to inform their practice, with research targeting the most relevant issues, including complex humanitarian emergency situations that increase health issues and challenge health infrastructure. For this to be achieved, a scoping review of the indexed clinical nursing and midwifery literature in the Middle East was performed to identify gaps in clinical nursing and midwifery research and areas requiring focus. A search of PubMed, CINAHL/EBSCO, EMBASE, the Jordanian Database for Nursing Research resulted in 210/1398 articles which met the inclusion criteria: (1) original research, (2) conducted in Middle Eastern countries as defined by the World Health Organization, (3) had at least one nurse or midwife author (but not limited to nurses in Middle Eastern countries), (4) published in an indexed, peer-reviewed journal between January 1, 2000, and December 31, 2015, (5) included patient outcomes in the results, (6) written in English or Arabic and (7) included an abstract. Studies were found from 10 of the 22 countries; the majority (n = 199; 94.76%) was conducted in three countries: Jordan, Iran and Lebanon. Most studies (n = 158, 75.24%) used quantitative designs, primarily cross-sectional, descriptive studies (n = 106) and the most frequently researched topics were related to maternal child health and women's health (n = 95, 48.5%). Strategies are needed to encourage collaboration between nursing and midwifery faculty members including clinicians to assure that clinical research is disseminated and used to improve patient care.

Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

Although midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters. The objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care. The qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters. Socially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional. This research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.

'To[o] much eating stifles the child': fat bodies and reproduction in early modern England .

This article examines associations between fat bodies and reproductive dysfunction that were prevalent in medical, midwifery and other literature in early modern England. In a period when fertility and successful reproduction were regarded as hugely important for social, economic and political stability such associations further contributed to negative attitudes towards fat bodies that were fuelled by connection with the vices of sloth and gluttony. Fat bodies were categorized as inherently, constitutionally, less sexual and reproductively successful. Consequently they were perceived as unhealthy and unfit for their primary purpose once they had reached sexual maturity: marriage and the production of children.