A five year follow-up study of the Bristol pregnancy domestic violence programme to promote routine enquiry

Objective

a follow-up study to evaluate the degree to which practice changes identified in the 2004/2005 evaluation of the Bristol Pregnancy Domestic Violence Programme (BPDVP) for routine enquiry for domestic abuse have been maintained.

Methods

a multimethod approach was adopted, using a follow-up survey and focus groups.

Setting

an acute Trust within the South West of England.

Participants

58 midwives completed the survey, 73% (n=36) of whom had taken part in the original study in 2004/2005. Eleven of those surveyed also participated in focus group interviews.

Measurements

participating midwives completed a 54-item questionnaire, where possible the questions were the same as those utilised in the original follow-up questionnaire. Similar to the previous study, the questionnaire was divided into a number of sections, including view of professional education, knowledge of domestic violence and abuse, attitudes and efficacy beliefs, barriers and support. The aim of the focus groups discussion was to obtain the overall views of midwives with the regard to the on-going implementation of routine enquiry. Frequency distributions for midwife responses in 2010 were compared with the corresponding frequency distributions in 2004/2005 and a statistical assessment of differences was performed using the χ² test of association.

Results

midwives have to feel confident in their abilities to ask about abuse and the findings from this study demonstrate that across the cohort there was a tendency to have an increase in confidence in asking about domestic violence. Midwives have to feel confident in their abilities to ask about abuse. The findings from this study demonstrate that across the cohort there was a statistically significant increase in self-reported confidence in asking women about domestic abuse. In addition, there was a statistically significant increase in the degree of self-reported knowledge of how to deal with a disclosure of domestic violence when comparing the 2010 data with 2005 data.

Conclusions

results suggest that improvements in antenatal enquiry for domestic violence and abuse developed through the 2004/2005 BPDVP have improved over time, with the support of mandatory training. Nevertheless, barriers continue to exist, which include presence of a male partner and lack of face to face interpreting services, both these obstacles need to be addressed if all women and, in particular those who are most at risk of abuse are to be identified and supported.     

Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden

Objective

to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden.

Design

an inductive qualitative design, using focus groups interviews.

Setting

midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals.

Findings

five categories emerged: ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. ‘Barriers towards asking the right questions’, the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. ‘Handling the delicate situation’, e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. ‘The crucial role of the midwife’, insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman.

Key conclusions and implication for practice

avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden.     

Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care—a national-based investigation into midwives’ alcohol-related education,knowledge and practice

Objective

to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy.

Design

a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians.

Setting

maternity health-care centres in Sweden.

Participant

2106 midwives.

Findings

nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers.

Key conclusions

more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.     

A study exploring UK midwives' knowledge and attitudes towards caring for women who have been sexually abused

Objective

to investigate midwives’ knowledge and attitudes in relation to caring for women who have been sexually abused.

Design

survey using a postal questionnaire. The questionnaire looked at midwives’ knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using χ²-test, logistic regression, Mann–Whitney U-test, Kruskal Wallis test and Mantel–Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London].

Setting

four National Health Service trusts within the East and West Midlands.

Participants

489 community and hospital-based midwives.

Findings

372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse (n=207, 56%), with a further 109 (29%) midwives being ‘unsure’ if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives (χ²=4.044, df=1, p=0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse.

Key conclusions and implications for practice

the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.     

Chinese midwives' views on a proposed midwife-led normal birth unit

Objective

to investigate and assess Chinese midwives’ views of their roles and ability to practice in a proposed midwife-led normal birth unit (MNBU).

Design

a self-completed questionnaire supplemented with semi-structured telephone interviews. Memos, diaries, correspondence and comments of Chinese collaborators were also accessed.

Setting

six hospitals in Hangzhou, the capital of Zhejiang province.

Participants

143 midwives were contacted and completed the questionnaire survey. Three midwives were subsequently interviewed.

Findings

the response rate was 100%; 86% of midwives supported the development of an MNBU, and 94.4% expressed confidence that they would be able to practice in an MNBU. The study shed new light on: (1) the meaning of an MNBU in the Chinese context; (2) the need for development of an MNBU; (3) role conflicts among midwives, doulas, nurses and obstetricians; (4) professional expertise and tension; and (5) the low status of Chinese midwives.

Conclusion

the proposed MNBU is welcomed by Chinese midwives. Their consensus and confidence show that there is enthusiasm for this project to proceed. However, the Chinese have never thought of MNBU services before. There is a need to develop well-structured philosophy, policy, procedures and outcome measures.

Implications for practice

the findings highlight the importance of an MNBU to re-establish Chinese midwives’ support of physiological childbirth. The extent to which Chinese midwives understand an MNBU could be further explored. The result may provide a possible route to the continuity of midwifery care and support.     

Development of an evidence-based domestic violence guideline: supporting perinatal women-centred care in Japan

Objective

to develop an evidenced-based, women-centred care clinical guideline designed to assist midwives and other health-care providers in Japanese hospitals, clinics and midwifery offices, in identifying and supporting potential or actual perinatal victims of domestic violence.

Design

systematic review and critical appraisal of extant research; structured assessment of clinical guideline development.

Method

systematic and comprehensive literature search. Appraisal of Guidelines for Research and Evaluation (AGREE) was used to assess the guideline development for purposes of assuring methodological quality.

Findings

electronic searches of medical and nursing databases between February and December 2003 retrieved 2392 articles. Selected as evidence were 157 articles yielding 28 recommendations aligned to clinical assessment questions.

Key conclusions

using expert consensus and external reviews, recommendations were generated that provided the at-risk perinatal group with the best possible practice available to prevent further harm.

Implications for practice

the evidenced-based clinical guideline fosters a supportive environment for educating health-care providers on domestic violence, and to improve clinic access for at-risk perinatal women. Information on domestic violence and a negotiated midwife–client safety plan can be initiated for potential or actual victims of domestic violence, and is achieved through understanding the risks of the woman and her fetus or baby, while respecting the woman's intention.     

Prediction of domestic violence against married women in southwestern Turkey

Objective

To determine the prevalence of, and independent risk factors for various domestic violence categories among married women of reproductive age in southwestern Turkey.

Methods

The present cross-sectional study included 260 randomly selected women registered to a family physician in the district of Gönen, Isparta. During home visits between October 1 and December 31, 2012, the women completed a questionnaire that included between four and eight questions for each violence category (physical, verbal, economic, emotional, and sexual) to assess the lifetime presence of domestic violence. Logistic regression models with backward elimination were constructed to define independent risk factors for domestic violence.

Results

In total, 176 (67.7%) women reported any type of domestic violence at least once in their lifetime. Verbal/psychological abuse was the most frequent type (reported by 121 [46.5%] women). Living in a village, young age (19–29 years) of the husband, adolescent age (< 19 years) of the husband at marriage, and problem alcohol use or problem gambling in the partner were independent predictors of domestic violence.

Conclusion

Attention should be given to area of residence, age of both partners at marriage, adolescent marriage, and husband characteristics during screening for domestic violence.     

Navigating a safe path together: A theory of midwives' responses to the use of complementary and alternative medicine

Objective

this paper presents the findings from a qualitative study that aimed to explain the processes midwives engaged in when considering the use of complementary and alternative medicine by pregnant women.

Design

grounded theory methodology was employed for the study. Data was generated from in-depth interviews and non-participant observation of midwives interacting with expectant mothers. Twenty-five midwives who worked in four hospitals and associated community clinics in Victoria, Australia, participated.

Findings

the theory ‘Navigating a safe path together’ offers a possible explanation of how midwives are responding. When working with women interested in the use of complementary and alternative medicine, midwives move through an iterative process of individualising pregnancy care, encountering diverse perspectives and minimising the risks associated with childbearing.

Key conclusion

at the heart of the theory is the meaning midwives' construct around safe childbirth and their professional roles. Despite widespread support for the therapies, midwives' actions in clinical practice are mediated by a number of factors including the context of their professional work, their beliefs and knowledge, and the woman's expectation and health.

Implications for practice

the research highlights the need for improved education and greater professional guidance to equip midwives to respond with greater understanding, and confidence to the increasing prevalence of CAM in the maternity setting.     

Disclosure and police reporting of intimate partner violence postpartum: a pilot study

Objective

intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum.

Design

a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum.

Findings

of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report.

Key conclusions

few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit.

Implications for practice

these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.     

Domestic abuse: Black and minority-ethnic women's perspectives

Background

domestic abuse affects one in three women in the UK and can have long-term consequences for those concerned and their families. Guidelines suggest that all women should be asked about domestic abuse, and the Department of Health has suggested ways of supporting this issue. Health-care professionals could find themselves with a woman who cannot speak English, and may require the support of an interpreter. Current guidelines are not suitable for Black and minority-ethnic women, and midwives may not have enough cultural awareness to support these women.

Aim

to interview bilingual women in the community to explore: (1) how domestic abuse is viewed in their culture; and (2) who should be questioning women about this sensitive issue.

Method

a qualitative phenomenological study using semi-structured interviews with non-pregnant bilingual workers within the local community.

Findings

women's lives were influenced by their in-laws and family, status, attitudes to marriage arrangements and gossiping in the community. All of these factors affected disclosure.

Conclusions

health-care professionals must understand that women take serious measures to hide the fact that they are victims of abuse in order to preserve family honour. Divulging information to interpreters or relatives is a problem because of lack of confidentiality and gossiping in the community.     

Birth environment facilitation by midwives assisting in non-hospital births: A qualitative interview study

Objective

midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved.

Design

semi-structured qualitative interview study and constant comparative analysis.

Participants

14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births.

Setting

Osaka, Kyoto, Nara, and Shiga, Japan.

Findings

midwives assisting at non-hospital births organised the birth environment based on the following four categories: ‘an environment where the mother and family are autonomous’; ‘a physical environment that facilitates birth’; ‘an environment that facilitates the movement of the mother for birth’; and ‘scrupulous safety preparation’. These, along with their sub-categories, are presented in this paper.

Key conclusions

independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research.     

Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile

Objective

to estimate the prevalence of poorer prenatal attachment and its association with psycho-affective factors in pregnant women during the third trimester.

Design and setting

cross-sectional study in Temuco, La Araucanía Region, Chile.

Measurements

data were collected by structured interview with closed questions for the sociodemographic characterisation of the sample and measurement of six aspects: prenatal attachment, perceived stress, depression, perception of relationship with partner, subjective family support, and obstetric information regarding current and previous pregnancies.

Participants

244 pregnant women selected by stratified random sampling in all centres (n=5) of the public health system in Temuco, Chile, with proportional allocation.

Findings

the prevalence of poorer prenatal attachment was 24.3% (95% confidence interval 19–30%), and this was found to be associated with discontent with the pregnancy, unwanted pregnancy, higher levels of perceived stress, depression and low family support. Religious activity and work were found to modulate the association between poorer prenatal attachment and psycho-affective aspects. The percentage of unplanned pregnancies was high in this study (61.35), and although this does not have a direct influence on poorer prenatal attachment, it is associated with discontent with the pregnancy and unwanted pregnancy.

Key conclusions and implications for practice

the high proportion of poorer prenatal attachment during the third trimester of pregnancy associated with potentially detectable psychosocial factors means that early diagnosis and timely intervention during prenatal care are an essential challenge for midwives in their work. Any progress that can be made during pregnancy will favour the development of the bonding experience after birth, and thus the balanced development of the child.     

Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden

Objective

to investigate whether practising midwives are adequately prepared to integrate genetic information into their practice.

Design

a cross-sectional, postal, structured questionnaire survey was sent to practising midwives.

Setting

practising midwives from the Netherlands (NL), Sweden (SE) and the United Kingdom (UK).

Participants

1021 replies were received, achieving a response rate of 62%.

Findings

79% (799/1015) of midwives reported attending courses with some ‘genetic content’ during their initial training. Sixty-eight per cent (533/784) judged this to have been useful for clinical practice. Variation was seen between countries in the amount of genetic content in post-registration training (SE 87%, NL 44%, UK 17%) and most was considered useful. Questions assessing clinical activity identified a current need for genetic knowledge. Midwives described low levels of self-reported confidence both in overtly genetic procedures and in everyday tasks that were underpinned by genetic knowledge. For eight of the 12 procedures, fewer than 20% of midwives considered themselves to be confident. Differences were apparent between countries. Midwives identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science.

Conclusions

given the low reported confidence with genetic issues in clinical practice, it is essential that this is addressed in terms of the amount, content and targeting of genetic education. This is especially important to ensure the success of national antenatal and baby screening programmes. The results of this study suggest that midwives would welcome further training in genetics, addressing genetic topics most relevant to their clinical practice.     

Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru

Objective

To examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru.

Methods

A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals.

Results

Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies.

Conclusion

The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings.     

Effectiveness of an educational programme in perineal repair for midwives

Objective

to evaluate the effectiveness of a work-based module and in-service educational programme in perineal repair for midwives on their perceived level of competency undertaking this skill in clinical practice.

Design

a quasi-experimental pre–post intervention case study combining a non-equivalent comparison group and evaluation action research.

Setting

six NHS consultant/midwifery led Trusts in South East England between December 2002 and 2006.

Participants

145 midwives from six NHS Trusts.

Interventions

a post-registration work-based module in perineal repair for midwives and alternative two hour in-service perineal repair workshops across five intervention Trusts.

Main outcome measures

midwives' perceived level of competency and confidence undertaking perineal repair.

Main findings

significantly greater numbers of midwives were able to practice perineal repair at higher levels of competency following an educational intervention in five intervention Trusts (P<.006). There was a non-significant difference in the comparison Trust (P<.535). In addition, an educational programme for midwives increased the numbers of senior student midwives who were able to participate in perineal repair confidently under the direct supervision of their mentor when they perceived that their mentor was confident and competent undertaking the procedure.

Key conclusions

an educational programme in perineal repair can make a significant difference to the midwives' perceived level of competency and confidence when assessing and managing perineal trauma and repair.

Implications for practice

competency and expertise are complex phenomena and the data has provided greater insight into the complex nature of workplace learning alongside the multiple factors influencing clinical decision-making such as staff shortage, time constraints and inadequate numbers of midwives who are able to instruct, supervise and assess competency in perineal repair. Funding for training is fundamental for the sustainability of future practice development.     

Organisational strategies and midwives' readiness to provide care for out of hospital births: An analysis from the Birthplace organisational case studies

Objective

the objective of the Birthplace in England Case Studies was to explore the organisational and professional issues that may impact on the quality and safety of labour and birth care in different birth settings: Home, Freestanding Midwifery Unit, Alongside Midwifery Unit or Obstetric Unit. This analysis examines the factors affecting the readiness of community midwives to provide women with choice of out of hospital birth, using the findings from the Birthplace in England Case Studies.

Design

organisational ethnographic case studies, including interviews with professionals, key stakeholders, women and partners, observations of service processes and document review.

Setting

a maximum variation sample of four maternity services in terms of configuration, region and population characteristics. All were selected from the Birthplace cohort study sample as services scoring ‘best’ or ‘better’ performing in the Health Care Commission survey of maternity services (HCC 2008).

Participants

professionals and stakeholders (n=86), women (64), partners (6), plus 50 observations and 200 service documents.

Findings

each service experienced challenges in providing an integrated service to support choice of place of birth. Deployment of community midwives was a particular concern. Community midwives and managers expressed lack of confidence in availability to cover home birth care in particular, with the exception of caseload midwifery and a ‘hub and spoke’ model of care. Community midwives and women's interviews indicated that many lacked home birth experience and confidence. Those in midwifery units expressed higher levels of support and confidence.

Key conclusions and implications for practice

maternity services need to consider and develop models for provision of a more integrated model of staffing across hospital and community boundaries.     

Occupational burnout and work factors in community and hospital midwives: A survey analysis

Background

community-based midwifery practice has been promoted in the UK maternity policy over the last decade as a means of increasing continuity of care. However, there have been growing concerns to suggest that the community-based continuity model may not be sustainable due to the high levels of occupational burnout in midwives resulted by increased on-call work.

Aims

this paper attempted to identify work factors associated with the levels of burnout in community midwives as compared to hospital midwives, aiming at contributing to the debate of organising sustainable midwifery care.

Methods

a statistical analysis was conducted drawing on data from a survey of all midwives working at one Hospital Trust in England (n=238). Occupational burnout was measured using the Maslach Burnout Inventory (MBI).

Results

the sample midwives (n=128, 54%) had significantly higher levels of burnout compared to the reference groups. Multiple regression analysis identified as follows: (1) high levels of occupational autonomy were a key protective factor of burnout, and more prevalent in the community, (2) working hours were positively associated with burnout, and community midwives were more likely to have higher levels of stress recognition, and (3) support for work-life-balance from the Trust had a significant protective effect on the levels of burnout.

Conclusion

the results should be taken into account in the maternity policy in order to incorporate continuity of care and sustainable organisation of midwifery care.     

Women's use of complementary and alternative medicines during pregnancy: A cross-sectional study

Objective

to determine the prevalence of women's use of complementary and alternative medicines (CAM) during pregnancy in the UK, reasons for use, who recommended CAM, and the characteristics of women that are associated with use of CAM during pregnancy.

Design

cross-sectional questionnaire.

Setting

Birmingham Women's Hospital.

Participants

315 postnatal women were surveyed while on the postnatal ward.

Findings

the questionnaire response rate was 89% (315/355). CAM use during pregnancy was reported by 180 women (57.1%). CAM users differed significantly from non-CAM users by education level, parity and previous CAM use before pregnancy. Vitamins (34.9%), massage therapy (14.0%), yoga (11.1%) and relaxation (10.2%) were the most commonly reported uses of CAM. 33.0% of women reported they did not disclose their use of CAM to a doctor or midwife, and 81.3% were not asked by their doctor or midwife about their use of CAM during pregnancy.

Key conclusions and implications for practice

this study found a high prevalence of CAM use during pregnancy, which is within the range of findings of studies from Australia and Germany. It is important that health-care providers routinely ask about CAM use during pregnancy and are able to provide pregnant women with appropriate advice regarding CAM use.     

Midwives' use of complementary/alternative treatments

Background

in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.

Objective

to systematically review all surveys of CAT use by midwives.

Search strategy

six electronic databases were searched using text terms and MeSH for CAT and midwifery.

Selection criteria

surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.

Data collection and analysis

full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.

Main results

19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.

Conclusion

most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.     

A qualitative investigation of alcohol use advice during pregnancy: Experiences of Dutch midwives,pregnant women and their partners

Objective

two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy.

Design

study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model.

Setting

study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands.

Participants

10 midwives in Study 1; 25 pregnant women and nine partners in Study 2.

Measurements and findings

study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals.

Key conclusions

midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy.

Implications for practice

training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media campaigns, should also be considered to change views about alcohol use during pregnancy in all stakeholders.