“Being a midwife is similar to being an Apache pilot. That may sound strange, but it’s true. One may suppose flying gunships in combat as far removed from delivering babies as can possibly be, but the truth is, there are…
Midwives are heroes…
Unexpected home birth: let’s keep our shoelaces on…
A woman whose husband recently called 999 when he realised that their baby was going to be born at home – unexpectedly, after a relatively fast first labour – was given some interesting advice. “Take one of your shoelaces out…
Untangling tocophobia
A year or so ago, a pregnant woman asked me a really good question, which I answered briefly in a blog post (Wickham 2016). ‘What is it called,’ she asked, ‘when you’re fearful of medicalisation?’ I couldn’t come up with…
What’s an Aqua APGAR?
“What’s an Aqua APGAR?” After I wrote a blog post sharing the results of some new studies highlighting the benefits of water in labour, a few people contacted us to ask for more information on the Aqua APGAR, which was…
What are the downsides of information?
When I returned to my desk after the holidays, I read a fascinating piece in the British Medical Journal by Semsarian and Moynihan (2017) who told the story of John, a 32 year old man whose father had given him…
More benefits of water for birth
The results of two recent research studies have added to our knowledge about the benefits of water for labour and birth. The first, a Swedish comparative study by Ulfsdottir et al (2017), found that women giving birth in water had…
The perils of cyberchondria
My working day got off to a slow start on the day I originally wrote this article, mainly because of Wikipedia! Within minutes of turning my computer on, I was contacted by a woman whose births I attended a few…
A potpourri of festive pondering on women, birth and midwifery
As someone who is fully subscribed to the notion that ongoing learning and growth are intrinsic, essential and joyful elements of living, searching out new knowledge is a big part of my daily life. Some of that knowledge gets turned…
Number Crunching
When I first wrote the article that this blog post is based upon, I had just finished reading a superb book, The Tyranny of Numbers by economist David Boyle (2001). In it, he critiqued our society’s reliance on and obsession…
Vitamin K Resources
This post is a collection of links to articles and resources that I have authored on the subject of vitamin K and I have now updated it to reflect the publication of the second edition of my book – which…
Yoga on YouTube!
I’ve shared several studies relating to the benefits of yoga on social media recently, and earlier this summer I had the pleasure of joining the YogaBirth teachers for their annual retreat, in order to offer an update on birth-related research.…
The ungentle art of persuasion
One of the great things about being allowed to write in midwifery journals is that, when you come across an article or idea that pleases you, annoys you or just makes you think harder than usual, you can share those…
Freedom … is much too precious
“The freedom to have a homebirth – whoever you are, wherever you live and whatever your situation – is much too precious to give up as if it were nothing.” – Ina May Gaskin Gaskin IM (2017). Choosing freedom…
Objectivity and post-it notes
Over the last few years, evidence-based practice has become a standard expectation of Western health care systems, rather than a topic whose value is debated by clinicians. Concurrently, rules of convention have developed, and it has now become politically correct…
On corporatization…
“Corporatization of medicine has led to a phenomenon found in all or most industries in a corporate system: the “productivity campaign.” This is an effort to get employees to work better and faster, although the “better” quickly falls away when…
Five posts you might have missed (or, an excuse to take my birthday off!)
It’s my birthday today! 😀 So first and foremost, a big thank you to my mum, who gave birth to me (at home and, in a feat of statistical improbability, on my due date) quite a few years ago now!…
Castor oil for labour induction
A study has looked at birthing outcomes of 323 women who used castor oil as part of an attempt to induce their labour, with interesting results. The study was carried out in the US where, in contrast to countries like…
More evidence for rebozos…
I’ve been really amazed by the number of people who have been in touch to thank me for the two-part article that I have shared over the past few weeks about the evidence for rebozo use. (You can read part…
The evidence for rebozos – part 2
Last month, I shared the story of my own introduction to the rebozo: a Mexican shawl whose popularity has grown in midwifery conferences and workshops to the extent that it is now used and taught by a number of midwives…
A tool to help parents to spot neonatal infection
In my blog post about the updated UK guidance on preventing early onset group B strep (GBS) disease (Hughes et al 2017), I mentioned that there was a call for all pregnant women to be provided with appropriate information about…
Protecting the perineum: midwifery expertise
A recent study has added to our knowledge about the views and skills of midwives who have expertise in protecting women’s perineums during birth. The research, known as the ‘MEPPI study’ is described as a qualitative exploratory study and the…
Updated UK GBS guideline
The Royal College of Obstetricians and Gynaecologists has published an update to their guidance on preventing early onset group B strep (GBS) disease. The guidance calls for all pregnant women to be provided with appropriate information about GBS to support…
What is person-centred care?
A student midwife recently asked, ‘Do you have a good explanation of ‘person-centred care’?’ Yes, thanks to a recent editorial in the British Medical Journal. “People-centered care moves away from traditional care models where care is determined by uniform procedures…
How professionals develop physiological breech birth skills
A recent research paper (Walker et al 2017) discusses the question of how professionals develop skills in facilitating physiological breech birth. This is an important question because, although there is a demand for physiological breech birth, many women find it…
Engendering rather than endangering trust
“Heavy-handed persuasion tactics and the aggressive language of some medically-focused papers and websites on the subject of vitamin K are not only inappropriate, but they harm relationships and make it less likely that parents will reach out for help if…
Deconstructing prophylaxis
It has long been thought that ‘prevention is better than cure’ and many of the things we routinely do in our lives are aimed at preventing disease and danger. If we get into a car, we put our seat belt…
Vitamin K and the Newborn – now available!
I am so excited to announce that the second edition of Vitamin K and the Newborn, a book written to help parents and professionals understand the evidence and the issues surrounding the administration of vitamin K to newborn babies, is…
The evidence for rebozos – part 1
About 20 years ago, it was while sitting on the floor among friends at a Midwifery Today conference that I first encountered the use of the colourful woven shawls that Mexican midwives call rebozos. During a workshop led by midwife…
The most challenging thing you will ever do…
“Parenting is, hands down, the most challenging thing you will ever do. It is scary, troubling, enthralling and exciting. It requires long hours, Herculean patience, trust and thousands of other skills and characteristics that our kids deserve and demand. As…
“Evidence based medicine misses the “art” of helping humans”
“Although evidence based medicine has reshaped medicine, nursing, and allied health professions into knowledge driven, scientific (sometimes pseudoscientific) professions, it fails to tackle the multifactorial reality of what actually happens to patients—the “art” of helping humans. The science of evidence…
Understanding more about birth and story…
I often hear midwives and birth folk lamenting the way that one-sided, fear-based, sometimes mysogynistic and frequently inaccurate depictions and representations of birth permeate modern culture, and I share their concerns. Participants in my workshops and online courses note the…
Pondering Domesticity…
My grandmother gave birth to all of her babies at home. There were simply no other options (Lee and Wickham 2000). But by the time her daughters were ready to birth, just a couple of decades later, they were offered…
What is the BRAN analysis?
What is the BRAN analysis? I have heard you speak about this, but I can’t find a simple explanation of what it means that I can share with my clients. Can you help? Yes I can. I did write about…
The words we use…
Midwives have done a lot of reflecting on their language over the last few years. While visible changes in practice inevitably take a while to evolve, there is a clear movement in the progressive midwifery literature from use of words…
Vaginal seeding – more data required?
A review article written by Danish doctors and published in the British Journal of Obstetrics and Gynaecology has stated that the benefits of vaginal seeding “do not outweigh the risks”. This paper and the inevitable news stories which have been…
What’s in a word?
‘Language is important and influential. I request that the Journal stop using (and letting authors use) the term obstetric when talking about midwifery care. Obstetrics is what obstetricians do, midwifery is what midwives do, and maternity care is what we…
Antibiotics and operative vaginal birth
The authors of an updated Cochrane review entitled ‘Antibiotic prophylaxis for operative vaginal delivery’ have drawn the same conclusion as in previous versions of the review: that routinely giving antibiotics to women who have forceps or ventouse births leads to…
The paracetamol question…
It occurred to me recently, while presenting on the topic of labour progress, that there is a blog post that I use frequently as a reference when I’m speaking about labour and birth – in particular, the question of what…
“A revolution is a transfer of power…”
“The Victorian parliamentarian and novelist Edward Bulwer-Lytton declared, “A reform is a correction of abuses; a revolution is a transfer of power.” Patient centred care began as a correction of abuses, a response to patients being treated like “imbeciles and…
Another ‘shared decision-making’ rant!
I’ve ranted before about what I see as the inappropriateness of the term ‘shared decision-making’ in medical circles. Calling a decision a ‘shared decision’ implies that the practitioner gets a say in what the person chooses. Yet when it comes…
Do midwives kiss babies?
For a few years now, I have been blogging regularly about birth, midwifery and my work in these areas and, as a result of this, I have learned quite a bit about how the Internet works. Blogs, for instance, come…
Women’s experience of vaginal birth after caesarean
Australian researchers have published a review and meta-synthesis of twenty research papers exploring women’s experience of vaginal birth after caesarean in a variety of birth locations. This is an important and valuable piece of work because, although we know that…
Birth outcomes and women of size
Another study has suggested that the differences in birth outcomes experienced by women of size may be due as much to provider attitudes and biases as to any intrinsic difference or disadvantage. Ellekjaer et al’s (2017) research, carried out in…
Ten tips for accessing academic papers online
When I post and discuss birth-related articles in my newsletter, blog or on social media, people often ask, “how can I see the full text of this?” I know this is a problem for many people. Because I work completely…
More evidence on targeting anti-D
A study carried out in Finland has provided more evidence of how we can use fetal rhesus group testing in order to offer anti-D prophylaxis only to those rhesus negative women who are carring rhesus positive babies and thus reduce…
Resources for questioning vaginal examination (2)
“Do you know of any good resources on the subject of questioning/declining vaginal examination? I’m thinking of vaginal examinations in a number of contexts – well woman exams, vaginal examinations in labour and especially at the end of pregnancy, as…
Resources for questioning vaginal examination (1)
“Do you know of any good resources on the subject of questioning/declining vaginal examination? I’m thinking of vaginal examinations in a number of contexts – well woman exams, vaginal examinations in labour and especially at the end of pregnancy, as…
Analysing water immersion guidelines
I recently read the most fascinating paper. Called ‘A critical analysis of Australian policies and guidelines for water immersion during labour and birth’, it aimed “to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to…
On birth trauma…
“Whilst for many women pregnancy and birth is a wonderful, life affirming experience, the findings from this study have highlighted how birth trauma can be experienced by women as a culmination of previous life events, pregnancy and birth trauma and…
The language of birth: crossing the Ts and promoting positivity
Language is something that we learn unconsciously rather than in a deliberate fashion, and in our busy world we often say things without thinking too much about why we say them or where they come from. But words have a…
Group B Strep: the realm of mysteries
“To study neonatal Streptococcal B infection is to enter the realm of mysteries… How to explain that microbes from maternal origin may be pathogenic for the baby? Several decades ago, we learned that, compared with the placenta of other mammals,…
The true midwives…
“Being with someone, murmuring along with their heartbeat, breathing with them, is a lost art. The true midwives of birth and death, those who keep vigil at the bedposts, are rare. They are the people whose eyes are accustomed to…
Perineal techniques during the second stage of labour for reducing perineal trauma
A new Cochrane review has been published on the subject of reducing perineal trauma by using certain techniques during the second stage of labour. This is a controversial topic and I know that this is going to be of interest…
A new online course: Group B Strep Explored!
I am very happy to announce the birth of my latest online course, Group B Strep Explored! Our online courses run on set dates, usually in the spring and autumn. You can see if we have current dates open on…
Women with diabetes and expressing breastmilk in pregnancy
Babies born to women who have diabetes are known to have a higher chance of experiencing hypoglycaemia (or low blood sugar). They are more likely to be admitted to a special care baby unit and there is a lower chance…
The art of knowing when to do nothing
“Our hands are skilled in the art of touching, of catching, of wiping the brow, but they should also be skilled in the art of knowing when to do nothing. Much too frequently eager birth attendants or doulas cannot just…
When even simple tools can harm…
A case study shared in this month’s International Journal of Obstetric Anesthesia carries an important warning message for women choosing to (and, almost more importantly, those supporting or working with women choosing to) use epidural or other forms of regional…
Informed consent – a redundancy?
“Informed consent is a redundancy, because being properly informed is a precondition of consent. Without being properly informed, a patient or client cannot give any legitimate, binding consent. Therefore, it is imperative that all professionals withhold any request for agreement…
Why it’s not necessarily about you
We know that many of the caesarean sections that are carried out today aren’t medically warranted. A related concern is that a proportion of these may be being carried out in the interests of profit rather than for the benefit…
Closeness after birth
A Finnish study exploring parent-infant closeness and separation has thrown more light on how hospital practices both promote closeness and cause separation in the first couple of hours after birth. And it’s kind of paradoxical, because the researchers discovered that,…