Improving quality and safety in maternity care: the contribution of midwife-led care.

This article draws on findings from a recent Cochrane systematic review of midwife-led care and discusses its contribution to the safety and quality of women's care in the domains of safety, effectiveness, woman-centeredness, and efficiency. According to the Cochrane review, women who received models of midwife-led care were nearly eight times more likely to be attended at birth by a known midwife, were 21% less likely to experience fetal loss before 24 weeks' gestation, 19% less likely to have regional analgesia, 14% less likely to have instrumental birth, 18% less likely to have an episiotomy, and significantly more likely to have a spontaneous vaginal birth, initiate breastfeeding, and feel in control. In addition to normalizing and humanizing birth, the contribution of midwife-led care to the quality and safety of health care is substantial.

Antenatal cardiotocography for fetal assessment.

Background: Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications.

Objectives: To assess the effectiveness of antenatal CTG (both traditional and computerised assessments) in improving outcomes for mothers and babies during and after pregnancy.

Psychosocial interventions for the prevention of disability following traumatic physical injury.

Background: Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.

Objectives: To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.

Search Strategy: The search was not restricted by date, language or publication status.

A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth.

The aim of this paper is to identify reviews of interventions for preventing and treating preterm birth so that these could be appraised and the findings from good quality reviews highlighted. Reviews, rather than individual studies, are the basis for this systematic review because of the proliferation of reviews and the benefits of a single, consistent appraisal and assessment of evidence from these reviews rather than further attempts to find and appraise the many individual studies in the literature. Our systematic review consists of a description of five interventions for preventing and treating preterm birth; antibiotics, cervical cerclage, bed rest, progesterone, and tocolytic therapy, for which at least one relevant review was found.

Midwife-led versus other models of care for childbearing women.

Background: Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care.

Objectives: To compare midwife-led models of care with other models of care for childbearing women and their infants.

Women's experiences of labour and birth: an evolutionary concept analysis.

Aim: the aim of this paper is to identify the core attributes of the experience of labour and birth.

Methods: a literature search was conducted using a variety of online databases for the years 1990-2005. A thematic analysis of a random sample of 62 of these papers identified the main characteristics of the experience of childbirth.

Educating advanced midwife practitioners: a collaborative venture.

Aim: To describe the collaborative development of an MSc course preparing Ireland's first advanced midwife practitioners.

Background: Ireland has 55 advanced nurse practitioner posts, but, as yet, no advanced midwife practitioners.

Methods: A consultative, collaborative process involving 38 midwives across Ireland generated the philosophy, aims and content of the course.

Evaluating maternity care: a core set of outcome measures.

Background: Comparing the relative effectiveness of interventions on specific outcomes across trials can be problematic due to differences in the choice and definitions of outcome measures used by researchers. We sought to identify a minimum set of outcome measures for evaluating models of maternity care from the perspective of key stakeholders.

Methods: A 3-round, electronic Delphi survey design was used.

A systematic review and quality assessment of systematic reviews of fetal fibronectin and transvaginal length for predicting preterm birth.

This systematic review aims to identify reviews of fetal fibronectin and transvaginal cervical length for predicting preterm birth, so that these could be appraised and the findings from good quality reviews highlighted. Reviews, rather than individual studies, are the basis for this systematic review because of the proliferation of reviews and the benefits of a single, consistent appraisal and assessment of evidence from these reviews, rather than further attempts to find and appraise the many individual studies in the literature. Potentially eligible reviews were sought primarily through searches of the electronic databases MEDLINE (1966-2005), EMBASE (1980-2005), CINHAL (1982-2005), Science Citation Index (1970-2005) and The Cochrane Library (Issue 3, 2005).

Unexpected diagnosis of fetal abnormality: women's encounters with caregivers.

Background: It is acknowledged that health professionals have difficulty with breaking bad news. However, relatively little research has been conducted on the experiences of women who have had a fetal anomaly detected at the routine pregnancy ultrasound examination. The study objective was to explore women's experiences of encounters with caregivers after the diagnosis of fetal anomaly at the routine second trimester ultrasound scan.

Exploring painful experiences: impact of emotional narratives on members of a qualitative research team.

Aim: This paper reports a study of the impact of emotional narratives on the well-being of members of a qualitative research team during the conduct of sensitive research.

Background: Qualitative data are frequently collected from participants using repeated in-depth interviews when exploring sensitive issues such as loss and grief. The research process can evoke highly emotional responses in the participant and others involved in the study.

Information, knowledge and expectations of the routine ultrasound scan.

Objective: To examine the current provision of pre-ultrasound information to women; to determine if the information provided was related to women's knowledge of the routine second trimester ultrasound; and to describe women's expectations of the scan.

Design: A descriptive survey, before and after design.

Setting: Tertiary referral centre in the Republic of Ireland.

A randomised-controlled trial evaluating a fetal monitoring education programme.

Objective: to evaluate the effectiveness of a fetal monitoring education programme on midwives' fetal monitoring knowledge and intrapartum cardiotocograph interpretation skills.

Design: two group, before-after, randomised-controlled trial.

Setting: two maternity hospitals in the Republic of Ireland.

Childbirth policies and practices in Ireland and the journey towards midwifery-led care.

Objective: To describe the dominant policies and practices that have governed childbirth in Ireland, and to outline the progress made towards the introduction of midwifery-led care in one health region.

Literature Review: A review of maternity-care policies in Ireland was conducted using government and regional health-authority documents and two historical reviews of government policies. A search was also carried out in PubMed and cinahl databases, using the keywords 'maternity care', 'childbirth', 'policy', 'midwifery-led', 'Ireland/Irish', with relevant Boolean and string operands.

Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement.

Aim: This paper reports an examination of intra- and inter-observer agreement in midwives' visual interpretation of intrapartum cardiotocographs (CTGs).

Background: The issue of intra- and inter-observer agreement in the interpretation of CTG interpretation has serious implications for the validity of electronic fetal heart rate monitoring and subsequent decisions on intrapartum management. However, no studies were found that assessed intra- and inter-observer agreement in midwives' interpretations of CTG tracings.

How many do I need? Basic principles of sample size estimation.

Background: In conducting randomized trials, formal estimations of sample size are required to ensure that the probability of missing an important difference is small, to reduce unnecessary cost and to reduce wastage. Nevertheless, this aspect of research design often causes confusion for the novice researcher.

Aim: This paper attempts to demystify the process of sample size estimation by explaining some of the basic concepts and issues to consider in determining appropriate sample sizes.