Dear Alison and colleagues,
Thanks, that is really helpful - I am kind of heartened by the knowledge that the IOL epidemic once subsided, and maybe our current upward trends will also subside over time. We do clearly have a multi-factorial increase in IOL, associated with over-intervention that has uncertain benefit for babies (in the sense that we don't really know yet which babies, if any, benefit and whether any identified benefits might come from one or from a combination of the SCB interventions, or from any of a number of other changes) and additional health burdens for women, as well as for resourcing intrapartum care.
I am always interested that the press reports that discuss increased IOL rates very quickly refer to increased complexity and women who are older at first pregnancy as the underlying justification, but I have never seen anything which shows the induction rate and broken this down into the reason(s) for IOL and trends for these, to substantiate this. I am not even sure whether primary reason for IOL is recorded, or recorded consistently enough, that this question could be answered. Perhaps we need something like a Robson categorisation for IOL, or a quality indicator for IOL decision-making, to help unpick what's happening here, or maybe there are already detailed reports available, that I'm not aware of? I'd love to know, if there are.
It's interesting to compare with the Scandinavian countries, many of which have high OU birth rates, but yet lower interventions, much like the early 90s here (I am so glad I gave birth then, even though I wasn't 'allowed' a home birth, I was much safer from over-intervention in OU than I would be now!)
Best wishes
Kirstie
From: Macfarlane, Alison <[log in to unmask]>
Sent: 26 October 2018 16:14
To: Coxon, Kirstie <[log in to unmask]>; A forum for discussion on midwifery and reproductive health research. <[log in to unmask]>
Subject: Re: New maternity statistics for England published today
Dear Kirstie,
A point I forgot to mention that the research in Cardiff in the 1970s was the MSc project of a young obstetrician just back from two years working in Gaza who went on to do an MSc in Public Health at London School of Hygiene. He criticised the unrandomised analysis of the 1958 perinatal mortality survey and said we needed randomised trials. If you haven't guessed, that was Iain Chalmers.
Alison
________________________________
From: Macfarlane, Alison
Sent: 26 October 2018 15:07
To: Coxon, Kirstie; A forum for discussion on midwifery and reproductive health research.
Subject: Re: New maternity statistics for England published today
What happened to induction in the 1970s was that an analysis of the 1958 perinatal mortality survey had been published showing that perinatal mortality was higher among post term than term babies. This was assumed to be causal rather than selection. So without looking for further evidence in an era when RCTs were few and far between and systematic reviewing hadn't yet been invented the powers that be decided that post term babies should all be induced. Then the definition of 'post term' widened so that the induction rate shot up to 44 per cent. This was challenged by the campaigning groups which were also campaigning for home births in reaction to the Peel Report, which had also decided, in the absence of evidence that all births should take place in hospital. There was some evidence to oppose the induction epidemic. An analysis of a 'natural experiment' comparing trends over time in two maternity units in Cardiff with very contrasting styles of practice failed to support the conclusion that rocketing rates of induction would reduce perinatal mortality. A key campaigner in this was Jean Robinson, who was very active in AIMS until the recent coup. Amazingly, the epidemic subsided. The gap in the data was because of change in data collection. It was difficult to collect data about induction in the previous system as it recorded ARM and oxytocics but didn't distinguish between their use for induction or augmentation, so the 44 per cent may be an overestimate, but the rate was certainly high. So a combination or research and strong minded campaigners seems to have been a key factor.
Today's epidemic, I gather, is in response to the late Secretary of State's 'ambition' to reduce our stillbirth rates to the same level as in Norway, where intervention rates are low and the midwifery profession is strong. Those of you who sit on committees can correct me, but I understand that two components of the 'Saving Babies Lives' care bundle are fetal movement counting, which the AFFIRM trial has shown didn't reduce stillbirth rates but did increase induction and caesarean rates and electronic fetal monitoring which also has been shown to increase intervention rates but not to decrease mortality.
It looks to me as if 'Saving Babies Lives' is much more powerful than any 'Maternity Transformation plans'. Are there any campaigners left out there, apart from those campaigning for caesarean section on demand and for privatisation of midwifery care?
Perhaps Norwegian midwives are the people to ask for advice?
Best wishes, Alison
________________________________
From: Coxon, Kirstie <[log in to unmask]<mailto:[log in to unmask]>>
Sent: 26 October 2018 12:19
To: A forum for discussion on midwifery and reproductive health research.; Macfarlane, Alison
Subject: RE: New maternity statistics for England published today
Dear Alison
Thanks for circulating these statistics and for sharing the attached graphs. Out of interest, do you, or other list members, know what on earth was happening with induction in the 1970s? (Graph 2) Or how it managed to rise and fall so dramatically? Perhaps there are lessons there for us now?
Best wishes
Kirstie
From: A forum for discussion on midwifery and reproductive health research.
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========================================================================Date: Mon, 29 Oct 2018 16:34:49 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Fiona Clare Dykes <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Fiona Clare Dykes <[log in to unmask]>
Subject: Re: Skin-to-skin contact at elective caesarean section
Comments: To: Juliet Wood <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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--_010_DB5PR0301MB1928AA7F5A36534F7287F1E0F6F30DB5PR0301MB1928_--
========================================================================Date: Mon, 29 Oct 2018 20:13:24 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
"Page, Lesley" <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: "Page, Lesley" <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
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Dear Susan and Mary
thanks for this.
Mary, I appreciate you responding to the list.
Personally I am very committed to the future midwife project. But visionary midwifery education will require strong regulation that supports autonomous midwifery while providing effective accountability to the public. There is insufficient evidence of support for this at present.
I share concern about the way the new midwifery panel of the NMC was formed, it seems without transparency to the profession, and with an inappropriate balance of midwives. I count 9 midwives out of 22-have I counted right? I kept going back to recount as I couldn't quite believe it.
The concerns of many from the profession's expressed through this group and other forums is clear.
Mary, you are one of the members of the panel. Is there a mechanism for you to raise concerns on our behalf ?
Our profession is at a critical point at present, with so much progress over recent decades, progressive government policy, but huge difficulty in implementing it into the NHS in England. I cannot speak for Scotland. Intervention rates are rising and free standing midwifery units closing to move staff to centralised services. There are other issues of concern that we need to be aware of.
It would be reassuring to know that regulation of midwifery as an autonomous profession is strong. This is not clear at present.
I suggest to all on the list that as a first step we should write to the Chair of the RCM Board with our concerns, and request a meeting, asking the RCM to represent our concerns to the NMC. In this process we could make clear our commitment to the Future Midwife Project.
I am not too sure how we would organise this but one or some of you may have ideas.
Many thanks and best wishes
Lesley
Professor Lesley Page CBE
Visiting Professor in Midwifery KCL
Adjunct professor UTS Australia
Griffith University Australia
Honorary research fellow Oxford Brookes University
mobile +44(o)7747708630
https://www.all4maternity.com/author/lesleypage/
<https://www.all4maternity.com/author/lesleypage/>twitter: lesleypageCBE@humanisingbirth
________________________________
From: A forum for discussion on midwifery and reproductive health research.
########################################################################
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========================================================================Date: Mon, 29 Oct 2018 21:09:28 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Lucia Rocca <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Lucia Rocca <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
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In-Reply-To: <[log in to unmask]>
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Dear all, dear Lesley,
I could not agree more!
I am really concerned about the status of midwifery as a profession in this
coutry. As I travel internationally British midwifery is still held as an
example of excellence and a point of reference. I am sometimes sad to admit
that things are not so great right now!
It is crucial that we do not move backwards rather than forwards. It seems
to me that midwives' autonomy is being at risk in the current climate.
As Midwifery Unit Network we are concerned about the closure of FMUs and
the limitation of choice of place of birth available to women. We are
experinencing an etraodinary 'backclash' against women's right to autonomy
as well as midwives' autonomy. This at a time when we could not have
stronger evidence in support of midwifery and midwife-led birth places! it
is classic! But this is why we need to be alert and vigilant, it takes no
time to go back to the past of midwifery being regulated by other
professions...
Let's stay strong and united!
...and let's get our own regulator.
Best wishes
Lucia
Dr Lucia Rocca-Ihenacho
PhD, MSc, RM
Lecturer in Midwifery and NIHR Research Fellow
Centre for Maternal and Child Health Research
School of Health Sciences
City University London
1 Myddelton Street
London
EC1R 1UW
07989 230313
Skype contact: luciainsky
On Mon, 29 Oct 2018 at 20:13, Page, Lesley <
[log in to unmask]> wrote:
> Dear Susan and Mary
>
>
> thanks for this.
>
>
> Mary, I appreciate you responding to the list.
>
>
> Personally I am very committed to the future midwife project. But
> visionary midwifery education will require strong regulation that supports
> autonomous midwifery while providing effective accountability to the
> public. There is insufficient evidence of support for this at present.
>
>
> I share concern about the way the new midwifery panel of the NMC was
> formed, it seems without transparency to the profession, and with an
> inappropriate balance of midwives. I count 9 midwives out of 22-have I
> counted right? I kept going back to recount as I couldn't quite believe it.
>
>
> The concerns of many from the profession's expressed through this group
> and other forums is clear.
>
>
> Mary, you are one of the members of the panel. Is there a mechanism for
> you to raise concerns on our behalf ?
>
>
> Our profession is at a critical point at present, with so much progress
> over recent decades, progressive government policy, but huge difficulty in
> implementing it into the NHS in England. I cannot speak for Scotland.
> Intervention rates are rising and free standing midwifery units closing to
> move staff to centralised services. There are other issues of concern that
> we need to be aware of.
>
>
> It would be reassuring to know that regulation of midwifery as an
> autonomous profession is strong. This is not clear at present.
>
>
> I suggest to all on the list that as a first step we should write to the
> Chair of the RCM Board with our concerns, and request a meeting, asking the
> RCM to represent our concerns to the NMC. In this process we could make
> clear our commitment to the Future Midwife Project.
>
>
> I am not too sure how we would organise this but one or some of you may
> have ideas.
>
>
> Many thanks and best wishes
>
>
>
> Lesley
>
> Professor Lesley Page CBE
> Visiting Professor in Midwifery KCL
> Adjunct professor UTS Australia
> Griffith University Australia
> Honorary research fellow Oxford Brookes University
>
> mobile +44(o)7747708630
>
>
>
> https://www.all4maternity.com/author/lesleypage/
>
> <https://www.all4maternity.com/author/lesleypage/>twitter:
> lesleypageCBE@humanisingbirth
>
>
>
>
>
>
>
> ________________________________
> From: A forum for discussion on midwifery and reproductive health research.
> ########################################################################
>
> To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:
> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1
>
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<div dir="ltr"><div>Dear all, dear Lesley,</div><div><br></div><div>I could not agree more!</div><div>I am really concerned about the status of midwifery as a profession in this coutry. As I travel internationally British midwifery is still held as an example of excellence and a point of reference. I am sometimes sad to admit that things are not so great right now! <br></div><div><br></div><div>It is crucial that we do not move backwards rather than forwards. It seems to me that midwives' autonomy is being at risk in the current climate. <br></div><div>As Midwifery Unit Network we are concerned about the closure of FMUs and the limitation of choice of place of birth available to women. We are experinencing an etraodinary 'backclash' against women's right to autonomy as well as midwives' autonomy. This at a time when we could not have stronger evidence in support of midwifery and midwife-led birth places! it is classic! But this is why we need to be alert and vigilant, it takes no time to go back to the past of midwifery being regulated by other professions...</div><div><br></div><div>Let's stay strong and united!</div><div>...and let's get our own regulator.</div><div><br></div><div>Best wishes</div><div><br></div><div>Lucia<br></div><div><br></div><div><br></div><div><br></div><div><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><div><div><span style="font-size:large"></span><span style="font-family:tahoma,sans-serif"><font size="2">Dr Lucia Rocca-Ihenacho</font></span></div><div><span style="font-family:tahoma,sans-serif"><font size="2">PhD, MSc, RM<br></font></span></div><span style="font-family:tahoma,sans-serif"></span><font size="2">Lecturer in Midwifery and NIHR Research Fellow</font><span><span style="font-family:tahoma,sans-serif"><font><span></span></font></span></span><br><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)"></span></span><div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)"></span></span><div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)">Centre for Maternal and Child Health Research</span></span></div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)">
</span></span><div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)">School of Health Sciences</span></span></div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)">
</span></span><div><span style="color:rgb(0,0,0)"><span style="background-color:rgb(255,255,255)">City Univers</span></span>ity London</div><div><br></div><div><br></div>
<div>1 Myddelton Street</div>
<div>London <br>EC1R 1UW</div></div><div><span style="font-family:tahoma,sans-serif"><font><span></span></font><font><span><br></span></font></span></div><span style="font-family:tahoma,sans-serif"><font><span>07989 230313</span></font></span></div><div dir="ltr"><font size="2">Skype contact: luciainsky</font><br></div><div dir="ltr"><div><span style="font-family:tahoma,sans-serif">
</span><font size="2"><span style="font-family:tahoma,sans-serif"></span><br></font></div><span style="font-size:large"><font face="'arial narrow', sans-serif"><br></font></span></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><br></div><br><div class="gmail_quote"><div dir="ltr">On Mon, 29 Oct 2018 at 20:13, Page, Lesley <<a href="mailto:[log in to unmask]">[log in to unmask]</a>> wrote:<br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">Dear Susan and Mary<br>
<br>
<br>
thanks for this.<br>
<br>
<br>
Mary, I appreciate you responding to the list.<br>
<br>
<br>
Personally I am very committed to the future midwife project. But visionary midwifery education will require strong regulation that supports autonomous midwifery while providing effective accountability to the public. There is insufficient evidence of support for this at present.<br>
<br>
<br>
I share concern about the way the new midwifery panel of the NMC was formed, it seems without transparency to the profession, and with an inappropriate balance of midwives. I count 9 midwives out of 22-have I counted right? I kept going back to recount as I couldn't quite believe it.<br>
<br>
<br>
The concerns of many from the profession's expressed through this group and other forums is clear.<br>
<br>
<br>
Mary, you are one of the members of the panel. Is there a mechanism for you to raise concerns on our behalf ?<br>
<br>
<br>
Our profession is at a critical point at present, with so much progress over recent decades, progressive government policy, but huge difficulty in implementing it into the NHS in England. I cannot speak for Scotland. Intervention rates are rising and free standing midwifery units closing to move staff to centralised services. There are other issues of concern that we need to be aware of.<br>
<br>
<br>
It would be reassuring to know that regulation of midwifery as an autonomous profession is strong. This is not clear at present.<br>
<br>
<br>
I suggest to all on the list that as a first step we should write to the Chair of the RCM Board with our concerns, and request a meeting, asking the RCM to represent our concerns to the NMC. In this process we could make clear our commitment to the Future Midwife Project.<br>
<br>
<br>
I am not too sure how we would organise this but one or some of you may have ideas.<br>
<br>
<br>
Many thanks and best wishes<br>
<br>
<br>
<br>
Lesley<br>
<br>
Professor Lesley Page CBE<br>
Visiting Professor in Midwifery KCL<br>
Adjunct professor UTS Australia<br>
Griffith University Australia<br>
Honorary research fellow Oxford Brookes University<br>
<br>
mobile +44(o)7747708630<br>
<br>
<br>
<br>
<a href="https://www.all4maternity.com/author/lesleypage/" rel="noreferrer" target="_blank">https://www.all4maternity.com/author/lesleypage/</a><br>
<br>
<<a href="https://www.all4maternity.com/author/lesleypage/" rel="noreferrer" target="_blank">https://www.all4maternity.com/author/lesleypage/</a>>twitter: lesleypageCBE@humanisingbirth<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
________________________________<br>
From: A forum for discussion on midwifery and reproductive health research.<br>
########################################################################<br>
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</blockquote></div></div>
<br>
<hr>
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--000000000000758d56057964807a--
========================================================================Date: Tue, 30 Oct 2018 08:24:23 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Ellie Jenkins <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Ellie Jenkins <[log in to unmask]>
Subject: Re: New maternity statistics for England published today
Comments: To: [log in to unmask]
In-Reply-To: <[log in to unmask]>
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Hello Trixie
Would you be able to give a little more information about cEFM and
intermittent auscultation? Is there any recent evidence based guidance
available? I am aware that there is a movement toward cEFM for everyone
and the re-establishment of the admission trace - I would like to see the
evidence so I can support my unit in the best way.
Thank you
Elinor
Midwife
Isle of Wight
On Mon, Oct 29, 2018 at 9:08 AM Trixie McAree <[log in to unmask]>
wrote:
> Thanks Alison for a good and helpful summary.
> About the Saving babies lives Care Bundle - you are right one element is
> about fetal movements - I am very interested to see what happens to local
> guidelines and process as a result of AFFIRM - I shared the findings as
> widely as I could.
> The second in relation to fetal monitoring is about both electronic and
> intermittent auscultation and about ensuring staff are properly educated
> do this as effectively as possible - although I know we are all aware of
> the caveats for this.
> Best wishes
>
> Trixie
>
> --------------------------------------------------------------------------------------------------------
>
> Professor Trixie McAree
> Professor of Midwifery and Maternal Health
>
> City South Campus, Ravensury 218/Birmingham Womens Hospital site
> Birmingham City University/ Birmingham Womens and Childrens NHS Foundation
> Trust
> B15 3TN
>
> DL: 0121 3316196
> Mob: 07894802961
>
> https://orcid.org/0000-0001-7845-2195
>
>
>
>
> -----Original Message-----
> From: A forum for discussion on midwifery and reproductive health
> research. [mailto:[log in to unmask]] On Behalf Of
> Macfarlane, Alison
> Sent: 26 October 2018 16:14
> To: [log in to unmask]
> Subject: Re: New maternity statistics for England published today
>
> Dear Kirstie,
>
>
> A point I forgot to mention that the research in Cardiff in the 1970s was
> the MSc project of a young obstetrician just back from two years working in
> Gaza who went on to do an MSc in Public Health at London School of Hygiene.
> He criticised the unrandomised analysis of the 1958 perinatal mortality
> survey and said we needed randomised trials. If you haven't guessed, that
> was Iain Chalmers.
>
>
> Alison
>
>
> ________________________________
> From: Macfarlane, Alison
> Sent: 26 October 2018 15:07
> To: Coxon, Kirstie; A forum for discussion on midwifery and reproductive
> health research.
> Subject: Re: New maternity statistics for England published today
>
>
> What happened to induction in the 1970s was that an analysis of the 1958
> perinatal mortality survey had been published showing that perinatal
> mortality was higher among post term than term babies. This was assumed to
> be causal rather than selection. So without looking for further evidence in
> an era when RCTs were few and far between and systematic reviewing hadn't
> yet been invented the powers that be decided that post term babies should
> all be induced. Then the definition of 'post term' widened so that the
> induction rate shot up to 44 per cent. This was challenged by the
> campaigning groups which were also campaigning for home births in reaction
> to the Peel Report, which had also decided, in the absence of evidence that
> all births should take place in hospital. There was some evidence to oppose
> the induction epidemic. An analysis of a 'natural experiment' comparing
> trends over time in two maternity units in Cardiff with very contrasting
> styles of practice failed to support the conclusion that rocketing rates of
> induction would reduce perinatal mortality. A key campaigner in this was
> Jean Robinson, who was very active in AIMS until the recent coup.
> Amazingly, the epidemic subsided. The gap in the data was because of change
> in data collection. It was difficult to collect data about induction in the
> previous system as it recorded ARM and oxytocics but didn't distinguish
> between their use for induction or augmentation, so the 44 per cent may be
> an overestimate, but the rate was certainly high. So a combination or
> research and strong minded campaigners seems to have been a key factor.
>
>
> Today's epidemic, I gather, is in response to the late Secretary of
> State's 'ambition' to reduce our stillbirth rates to the same level as in
> Norway, where intervention rates are low and the midwifery profession is
> strong. Those of you who sit on committees can correct me, but I understand
> that two components of the 'Saving Babies Lives' care bundle are fetal
> movement counting, which the AFFIRM trial has shown didn't reduce
> stillbirth rates but did increase induction and caesarean rates and
> electronic fetal monitoring which also has been shown to increase
> intervention rates but not to decrease mortality.
>
>
> It looks to me as if 'Saving Babies Lives' is much more powerful than any
> 'Maternity Transformation plans'. Are there any campaigners left out there,
> apart from those campaigning for caesarean section on demand and for
> privatisation of midwifery care?
>
>
> Perhaps Norwegian midwives are the people to ask for advice?
>
>
> Best wishes, Alison
>
>
> ________________________________
> From: Coxon, Kirstie <[log in to unmask]>
> Sent: 26 October 2018 12:19
> To: A forum for discussion on midwifery and reproductive health research.;
> Macfarlane, Alison
> Subject: RE: New maternity statistics for England published today
>
>
> Dear Alison
>
> Thanks for circulating these statistics and for sharing the attached
> graphs. Out of interest, do you, or other list members, know what on earth
> was happening with induction in the 1970s? (Graph 2) Or how it managed to
> rise and fall so dramatically? Perhaps there are lessons there for us now?
>
>
>
> Best wishes
>
>
>
> Kirstie
>
>
>
> From: A forum for discussion on midwifery and reproductive health research.
> ########################################################################
>
> To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:
> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1
>
> ########################################################################
>
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>
--
*Elinor Jenkins*
*077 481 266 39*
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<div dir="ltr"><div class="gmail_default" style="font-family:garamond,serif">Hello Trixie</div><div class="gmail_default" style="font-family:garamond,serif">Would you be able to give a little more information about cEFM and intermittent auscultation? Is there any recent evidence based guidance available? I am aware that there is a movement toward cEFM for everyone and the re-establishment of the admission trace - I would like to see the evidence so I can support my unit in the best way.</div><div class="gmail_default" style="font-family:garamond,serif">Thank you</div><div class="gmail_default" style="font-family:garamond,serif">Elinor</div><div class="gmail_default" style="font-family:garamond,serif">Midwife</div><div class="gmail_default" style="font-family:garamond,serif">Isle of Wight</div></div><br><div class="gmail_quote"><div dir="ltr">On Mon, Oct 29, 2018 at 9:08 AM Trixie McAree <<a href="mailto:[log in to unmask]">[log in to unmask]</a>> wrote:<br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">Thanks Alison for a good and helpful summary.<br>
About the Saving babies lives Care Bundle - you are right one element is about fetal movements - I am very interested to see what happens to local guidelines and process as a result of AFFIRM - I shared the findings as widely as I could.<br>
The second in relation to fetal monitoring is about both electronic and intermittent auscultation and about ensuring staff are properly educated do this as effectively as possible - although I know we are all aware of the caveats for this.<br>
Best wishes<br>
<br>
Trixie<br>
--------------------------------------------------------------------------------------------------------<br>
<br>
Professor Trixie McAree<br>
Professor of Midwifery and Maternal Health<br>
<br>
City South Campus, Ravensury 218/Birmingham Womens Hospital site<br>
Birmingham City University/ Birmingham Womens and Childrens NHS Foundation Trust<br>
B15 3TN<br>
<br>
DL: 0121 3316196<br>
Mob: 07894802961<br>
<br>
<a href="https://orcid.org/0000-0001-7845-2195" rel="noreferrer" target="_blank">https://orcid.org/0000-0001-7845-2195</a><br>
<br>
<br>
<br>
<br>
-----Original Message-----<br>
From: A forum for discussion on midwifery and reproductive health research.<br>
<hr>
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</p>
========================================================================Date: Tue, 30 Oct 2018 10:06:23 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
MacVane Phipps Fiona <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: MacVane Phipps Fiona <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: Lucia Rocca <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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Lesley, Lucia,
I strongly share your concerns. It is inefective to become excited over new initiatives for midwifery education until we can state categorically that we are educating midwives as autonomous professionals. I have recently returned from Canada where midwifery is still an emerging profession (as you well know, Lesley). I visited birth centres (Maisons de Naissance) in Quebec province and in Ottawa and what struck me the most was the strength of autonomy displayed by the midwives I spoke to. A friend who is a Professor at Trois Rivieres (the only midwifery training in Quebec province) told me she is running a conversion course for foreign midwives but midwives on the ground said even with this, many foreign midwives who have worked in largely hospital settings find it very difficult to adapt to the level of autonomy required to work in a caseload continuity model of care. In the UK I see us moving further away from being an autonomous, self regulating profession despite the wealth of empirical evidence which demonstrates the safety and the benefits to mothers and babies of the midwifery model of care provided by a strong autonomous midwifery profession. I would be very interested in being involved in any discourse on this topic about how we can create the changes necessary to strengthen midwifery as an independent professional group working in collaboration with obstetrics, nursing, paediatrics, physiotherapy, psychiatric nursing, etc.
Kind regards,
Fiona MacVane Phipps
PhD, M.Med.Sci, RM, PGCE (HE) FHEA
Senior Research Fellow (Midwifery)
University of Salford
http://fionaphipps.com/
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========================================================================Date: Tue, 30 Oct 2018 10:16:51 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
"Page, Lesley" <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: "Page, Lesley" <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: MacVane Phipps Fiona <[log in to unmask]>
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Dear Fiona
I think some work on autonomy would be really useful.
It is perhaps through a combination of the right education, the right regulation and the opportunity to practice in settings like continuity of carer, primary care midwifery ( including midwifery led care in and out of hospitals), that professional autonomy, within a framework of collaboration, is achieved.
I learned a great deal from Canada-but we must remember that midwifery is not accessible to all there. Perhaps we should be looking to New Zealand?
thanks and best wishes
Lesley
Professor Lesley Page CBE
Visiting Professor in Midwifery KCL
Adjunct professor UTS Australia
Griffith University Australia
Honorary research fellow Oxford Brookes University
mobile +44(o)7747708630
https://www.all4maternity.com/author/lesleypage/
<https://www.all4maternity.com/author/lesleypage/>twitter: lesleypageCBE@humanisingbirth
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========================================================================Date: Tue, 30 Oct 2018 11:42:43 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
MacVane Phipps Fiona <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: MacVane Phipps Fiona <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: "Page, Lesley" <[log in to unmask]>
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Dear lesley
Thanks for your response. I do agree that NZ is a model which is more easily adaptable for the UK and that retaining midwifery care for all women as part of the NHS is essential. What struck me about the Canadian, or more specifically the Quebecoise midwives to whom I spoke was their deep understanding of the centrality of autonomy in their practice. I think this is a topic which deserves more exploration in the UK.
Kind regards
Fiona
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========================================================================Date: Tue, 30 Oct 2018 12:29:53 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
"Macfarlane, Alison" <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: "Macfarlane, Alison" <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: MacVane Phipps Fiona <[log in to unmask]>
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Dear all,
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.
Good luck and I hope you do better than King Canute.
Alison Macfarlane
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MacVane Phipps Fiona
Sent: 30 October 2018 11:43
To: [log in to unmask]
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear lesley
Thanks for your response. I do agree that NZ is a model which is more easily adaptable for the UK and that retaining midwifery care for all women as part of the NHS is essential. What struck me about the Canadian, or more specifically the Quebecoise midwives to whom I spoke was their deep understanding of the centrality of autonomy in their practice. I think this is a topic which deserves more exploration in the UK.
Kind regards
Fiona
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From: A forum for discussion on midwifery and reproductive health research.
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========================================================================Date: Tue, 30 Oct 2018 12:55:35 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
MacVane Phipps Fiona <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: MacVane Phipps Fiona <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: "Macfarlane, Alison" <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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Alison
Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.
Best wishes,
Fiona
________________________________
From: Macfarlane, Alison <[log in to unmask]>
Sent: 30 October 2018 12:29:53
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear all,
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.
Good luck and I hope you do better than King Canute.
Alison Macfarlane
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MacVane Phipps Fiona
Sent: 30 October 2018 11:43
To: [log in to unmask]
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear lesley
Thanks for your response. I do agree that NZ is a model which is more easily adaptable for the UK and that retaining midwifery care for all women as part of the NHS is essential. What struck me about the Canadian, or more specifically the Quebecoise midwives to whom I spoke was their deep understanding of the centrality of autonomy in their practice. I think this is a topic which deserves more exploration in the UK.
Kind regards
Fiona
________________________________
From: A forum for discussion on midwifery and reproductive health research.
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<p style="margin-top:0;margin-bottom:0">Alison</p>
<p style="margin-top:0;margin-bottom:0">Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts
to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care
and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.</p>
<p style="margin-top:0;margin-bottom:0">Best wishes,</p>
<p style="margin-top:0;margin-bottom:0">Fiona<br>
</p>
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<div id="divRplyFwdMsg" dir="ltr"><font face="Calibri, sans-serif" style="font-size:11pt" color="#000000"><b>From:</b> Macfarlane, Alison <[log in to unmask]><br>
<b>Sent:</b> 30 October 2018 12:29:53<br>
<b>To:</b> A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona<br>
<b>Subject:</b> RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)</font>
<div> </div>
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<div class="BodyFragment"><font size="2"><span style="font-size:11pt;">
<div class="PlainText">Dear all,<br>
<br>
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
<br>
<br>
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants
to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.<br>
<br>
Good luck and I hope you do better than King Canute.<br>
<br>
Alison Macfarlane<br>
<br>
-----Original Message-----<br>
From: A forum for discussion on midwifery and reproductive health research.<br>
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========================================================================Date: Tue, 30 Oct 2018 19:22:30 +0000
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"McCourt, Christine" <[log in to unmask]>
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========================================================================Date: Tue, 30 Oct 2018 20:24:20 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Robyn Maude <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Robyn Maude <[log in to unmask]>
Subject: Re: New maternity statistics for England published today
Comments: To: Ellie Jenkins <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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========================================================================Date: Wed, 31 Oct 2018 10:42:58 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
"Macfarlane, Alison" <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: "Macfarlane, Alison" <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: MacVane Phipps Fiona <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don't think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action.
Alison Macfarlane
From: MacVane Phipps Fiona [mailto:[log in to unmask]]
Sent: 30 October 2018 12:56
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research.
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Alison
Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.
Best wishes,
Fiona
________________________________
From: Macfarlane, Alison <[log in to unmask]>
Sent: 30 October 2018 12:29:53
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear all,
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.
Good luck and I hope you do better than King Canute.
Alison Macfarlane
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MacVane Phipps Fiona
Sent: 30 October 2018 11:43
To: [log in to unmask]
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear lesley
Thanks for your response. I do agree that NZ is a model which is more easily adaptable for the UK and that retaining midwifery care for all women as part of the NHS is essential. What struck me about the Canadian, or more specifically the Quebecoise midwives to whom I spoke was their deep understanding of the centrality of autonomy in their practice. I think this is a topic which deserves more exploration in the UK.
Kind regards
Fiona
________________________________
From: A forum for discussion on midwifery and reproductive health research.
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended
the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing
levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all
happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Alison Macfarlane
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span lang="EN-US" style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> MacVane Phipps Fiona [mailto:[log in to unmask]]
<br>
<b>Sent:</b> 30 October 2018 12:56<br>
<b>To:</b> Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research.<br>
<b>Subject:</b> Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p><span style="font-family:"Calibri","sans-serif";color:black">Alison<o:p></o:p></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured,
to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence
supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.<o:p></o:p></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Best wishes,<o:p></o:p></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Fiona<o:p></o:p></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"> Macfarlane, Alison <[log in to unmask]><br>
<b>Sent:</b> 30 October 2018 12:29:53<br>
<b>To:</b> A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona<br>
<b>Subject:</b> RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)</span>
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<p class="MsoNormal"><span style="font-size:11.0pt">Dear all,<br>
<br>
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
<br>
<br>
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants
to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.<br>
<br>
Good luck and I hope you do better than King Canute.<br>
<br>
Alison Macfarlane<br>
<br>
-----Original Message-----<br>
From: A forum for discussion on midwifery and reproductive health research.<br>
<hr>
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</p>
========================================================================Date: Wed, 31 Oct 2018 13:11:02 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Claire Feeley <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Claire Feeley <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
In-Reply-To: <[log in to unmask]>
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Dear all,
Thank you for an interesting and thoughtful discussion regarding these matters. I do agree there are significant concerns in midwifery at present. However, I am hoping that my PhD study will help contribute to providing some great data where (some) midwives in the UK are managing to practice autonomously. This work has captured the experiences of 45 midwives across the UK who have facilitated women's outwith guidelines birth choices where the women were seeking physiological births. The birth choices ranged from those just 'nudging' outside of guidelines to very complex situations. Beyond the immediate practice based knowledge that the study was initially designed for, very interesting insights have emerged regarding proactive woman-centred organisations in which have enabled some of the midwives to practice autonomously with supportive management/leaders/MDT etc. I am currently in the final stages of writing up, with view to submit end of March 2019, so I hope this work can, in some small way, offer a contribution to what is working, and how it is working in some places. Whilst of course acknowledging there is much more that needs to be done.
Best wishes,
Midwife/PhD Student
University of Central Lancashire
https://www.researchgate.net/profile/Claire_Feeley
On Wednesday, 31 October 2018, 10:43:09 GMT, Macfarlane, Alison <[log in to unmask]> wrote:
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We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action.
Alison Macfarlane
From: MacVane Phipps Fiona [mailto:[log in to unmask]]
Sent: 30 October 2018 12:56
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research.
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Alison
Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.
Best wishes,
Fiona
From: Macfarlane, Alison <[log in to unmask]>
Sent: 30 October 2018 12:29:53
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)
Dear all,
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.
Good luck and I hope you do better than King Canute.
Alison Macfarlane
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:
https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1
########################################################################
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<html><head></head><body><div class="ydpdeca21a7yahoo-style-wrap" style="font-family: Helvetica Neue, Helvetica, Arial, sans-serif; font-size: 13px;"><div></div>
<div>Dear all,</div><div><br></div><div>Thank you for an interesting and thoughtful discussion regarding these matters. I do agree there are significant concerns in midwifery at present. However, I am hoping that my PhD study will help contribute to providing some great data where (some) midwives in the UK are managing to practice autonomously. This work has captured the experiences of 45 midwives across the UK who have facilitated women's outwith guidelines birth choices where the women were seeking physiological births. The birth choices ranged from those just 'nudging' outside of guidelines to very complex situations. Beyond the immediate practice based knowledge that the study was initially designed for, very interesting insights have emerged regarding proactive woman-centred organisations in which have enabled some of the midwives to practice autonomously with supportive management/leaders/MDT etc. I am currently in the final stages of writing up, with view to submit end of March 2019, so I hope this work can, in some small way, offer a contribution to what is working, and how it is working in some places. Whilst of course acknowledging there is much more that needs to be done.</div><div><br></div><div>Best wishes,</div><div><span><p>Midwife/PhD Student</p> <p>University of Central Lancashire</p> <a href="https://www.researchgate.net/profile/Claire_Feeley" class="ydp8b8edc96OWAAutoLink" id="ydp8b8edc96LPNoLP" rel="nofollow" target="_blank">https://www.researchgate.net/profile/Claire_Feeley</a></span><br></div><div><br></div>
</div><div id="yahoo_quoted_1404619752" class="yahoo_quoted">
<div style="font-family:'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;color:#26282a;">
<div>
On Wednesday, 31 October 2018, 10:43:09 GMT, Macfarlane, Alison <[log in to unmask]> wrote:
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<p class="yiv8159350141MsoNormal"><span style="font-size:11.0pt;">We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended
the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing
levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all
happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action.</span></p>
<p class="yiv8159350141MsoNormal"><span style="font-size:11.0pt;"> </span></p>
<p class="yiv8159350141MsoNormal"><span style="font-size:11.0pt;">Alison Macfarlane
</span></p>
<p class="yiv8159350141MsoNormal"><span style="font-size:11.0pt;"> </span></p>
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<p class="yiv8159350141MsoNormal"><b><span style="font-size:10.0pt;" lang="EN-US">From:</span></b><span style="font-size:10.0pt;" lang="EN-US"> MacVane Phipps Fiona [mailto:[log in to unmask]]
<br clear="none">
<b>Sent:</b> 30 October 2018 12:56<br clear="none">
<b>To:</b> Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research.<br clear="none">
<b>Subject:</b> Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)</span></p>
</div>
</div>
<p class="yiv8159350141MsoNormal"> </p>
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<p><span style="">Alison</span></p>
<p><span style="">Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured,
to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence
supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.</span></p>
<p><span style="">Best wishes,</span></p>
<p><span style="">Fiona</span></p>
<p><span style=""> </span></p>
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<p class="yiv8159350141MsoNormal"><b><span style="font-size:11.0pt;">From:</span></b><span style="font-size:11.0pt;"> Macfarlane, Alison <[log in to unmask]><br clear="none">
<b>Sent:</b> 30 October 2018 12:29:53<br clear="none">
<b>To:</b> A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona<br clear="none">
<b>Subject:</b> RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)</span>
</p>
<div>
<p class="yiv8159350141MsoNormal"> </p>
</div>
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<div>
<p class="yiv8159350141MsoNormal"><span style="font-size:11.0pt;">Dear all,<br clear="none">
<br clear="none">
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
<br clear="none">
<br clear="none">
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants
to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.<br clear="none">
<br clear="none">
Good luck and I hope you do better than King Canute.<br clear="none">
<br clear="none">
Alison Macfarlane<br clear="none">
<br clear="none">
-----Original Message-----<br clear="none">
From: A forum for discussion on midwifery and reproductive health research.<br clear="none">
</span></p><hr>
<p align="center">To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:<br clear="none">
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------=_Part_23367681_2030612399.1540991462597--
========================================================================Date: Wed, 31 Oct 2018 13:17:26 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Gillian Meldrum <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Gillian Meldrum <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: "Macfarlane, Alison" <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
MIME-Version: 1.0
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I think what is needed is an international & national normal birth strategy
with a co-ordinating body. The UNICEF Baby Friendly Initiative, in
partnership with WHO, is a good model to consider.
They have made slow but steady progress over the last 27 years, with many
challenges similar to normal birth.
It has to start with an understanding of why normal birth matters - the
increase in interventions is often lamented, but rarely do we see the
negative impacts of this or it’s often weak rationales explicitly stated in
the media or communicated to women.
The importance of normal birth, and how to achieve it, may be taught to
midwifery students, but not to doctors and most lay people are unaware.
BFI at a local level means setting policies & guidelines for best
evidence-based practice, training staff & auditing their skills, knowledge
& understanding, and most importantly, auditing mothers’ experiences so
that we hear their voices & find out if we are getting it right.
Nationally, they co-ordinate a national network of infant feeding leads who
link in to all maternity, neonatal, health visiting & children’s centre
staff in the country (except for some areas in England who are not signed
up). They have established standards for universities training midwives &
health visitors.
Currently they are working on a medical student curriculum.
They work together with other national bodies involved in
https://ukbreastfeeding.org/
They are a tiny unit, but have clear aims and focus - we have never had any
organisation promoting normal birth in such a structured way.
Who of you has contacts with WHO? We need an Innocenti Declaration for
normal birth and a an equivalent of the 10 steps framework to protect it.
Then a UK organisation which exists for the purpose of implementing those
standards.
On a slightly different note, I think the improvements in induction rates
in the 1990s can be partly attributed to the contribution of NCT & AIMS
which encouraged women to expect more oppprtunities for informed choice &
resulted in more women asking for less intervention, together with the
publication in 1989 of Chalmers et al Effective Care in Pregnancy &
Childbirth - this gave massive support to clinicians.
Gillian Meldrum
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]>
wrote:
> We have a lot more research evidence since the early 1990s when the
> policies first changed and more recent robust research which has confirmed
> and extended the earlier more limited evidence on which the policies were
> based. Although research questions remain, I don’t think more research is
> the prime need now. An outside observer can see the majority of women
> giving birth in ever larger obstetric units with rocketing levels of
> intervention and a few midwifery units and private midwifery companies for
> the minority of women who manage to find out that they have a choice. I
> know you midwives are run off your feet, but it looks like you have a
> choice between letting it all happen and becoming the RCOG / RCN Faculty of
> Obstetric Nursing or taking some action.
>
>
>
> Alison Macfarlane
>
>
>
> *From:* MacVane Phipps Fiona [mailto:[log in to unmask]]
> *Sent:* 30 October 2018 12:56
> *To:* Macfarlane, Alison; A forum for discussion on midwifery and
> reproductive health research.
> *Subject:* Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
> (#2018-190)
>
>
>
> Alison
>
> Thank you for this. I didn't see your graphs. were they circulated on this
> list? I find your suggestion very chilling yet very credible, particularly
> if this government plan, as widely rumoured, to throw open NHS contracts to
> any US trade deal. I can't think of anything worse than the UK maternity
> service being influenced/comtrolled by US care providers (read 'Insurance
> conglomerates'). I find it very hard to understand why the large body of
> evidence supporting midwifery care and the midwifery model of birth has
> failed to alter this trend. I'm happy to be involved in any discussion
> about research that could be done to investigate.
>
> Best wishes,
>
> Fiona
>
>
>
>
> ------------------------------
>
> *From:* Macfarlane, Alison <[log in to unmask]>
> *Sent:* 30 October 2018 12:29:53
> *To:* A forum for discussion on midwifery and reproductive health
> research.; MacVane Phipps Fiona
> *Subject:* RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
> (#2018-190)
>
>
>
> Dear all,
>
> I hope you don't mind me commenting on this from a statistical
> perspective. The graphs I circulated show that in England childbirth is
> changing but in a non-evidence-based direction that I think most people on
> this list think is wrong.
>
> How long before some hard-nosed finance person notices that fewer than
> half of births in England are spontaneous and proposes that a 'solution' to
> the shortage of midwives would be replacing a substantial number of
> midwifery posts with obstetric nursing assistants to help the obstetricians
> conduct an ever growing proportion of births? This reached 39 per cent in
> 2007-18.
>
> Good luck and I hope you do better than King Canute.
>
> Alison Macfarlane
>
> -----Original Message-----
> From: A forum for discussion on midwifery and reproductive health research.
> ------------------------------
>
> To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:
> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1
>
>
########################################################################
To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:
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--0000000000007373e905798620fd
Content-Type: text/html; charset="UTF-8"
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<div><div dir="auto">I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider.<div dir="auto">They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth.</div><div dir="auto">It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women.</div><div dir="auto">The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware.</div><div dir="auto">BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right.</div><div dir="auto">Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting & children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors.</div><div dir="auto">Currently they are working on a medical student curriculum.</div><div dir="auto">They work together with other national bodies involved in</div><div dir="auto"><a href="https://ukbreastfeeding.org/" target="_blank">https://ukbreastfeeding.org/</a></div><div dir="auto">They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way.</div><div dir="auto">Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards.</div><div dir="auto"><br></div><div dir="auto">On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians.</div><div dir="auto"><br></div><div dir="auto">Gillian Meldrum</div></div></div><div><div><br><div class="gmail_quote"><div dir="ltr">On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>> wrote:<br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">
<div lang="EN-GB" link="blue" vlink="purple">
<div class="m_-7789834207109108985m_8693960838167490883WordSection1">
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended
the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing
levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all
happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Alison Macfarlane
<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p>
<div>
<div style="border:none;border-top:solid #b5c4df 1.0pt;padding:3.0pt 0cm 0cm 0cm">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span lang="EN-US" style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> MacVane Phipps Fiona [mailto:<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>]
<br>
<b>Sent:</b> 30 October 2018 12:56<br>
<b>To:</b> Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research.<br>
<b>Subject:</b> Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)<u></u><u></u></span></p>
</div>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div id="m_-7789834207109108985m_8693960838167490883divtagdefaultwrapper">
<p><span style="font-family:"Calibri","sans-serif";color:black">Alison<u></u><u></u></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Thank you for this. I didn't see your graphs. were they circulated on this list? I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured,
to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence
supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate.<u></u><u></u></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Best wishes,<u></u><u></u></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black">Fiona<u></u><u></u></span></p>
<p><span style="font-family:"Calibri","sans-serif";color:black"><u></u> <u></u></span></p>
<div id="m_-7789834207109108985m_8693960838167490883Signature">
<div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"><u></u> <u></u></span></p>
</div>
</div>
</div>
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<hr size="2" width="98%" align="center">
</div>
<div id="m_-7789834207109108985m_8693960838167490883divRplyFwdMsg">
<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"> Macfarlane, Alison <<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>><br>
<b>Sent:</b> 30 October 2018 12:29:53<br>
<b>To:</b> A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona<br>
<b>Subject:</b> RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190)</span>
<u></u><u></u></p>
<div>
<p class="MsoNormal"> <u></u><u></u></p>
</div>
</div>
<div>
<div>
<p class="MsoNormal"><span style="font-size:11.0pt">Dear all,<br>
<br>
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong.
<br>
<br>
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants
to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18.<br>
<br>
Good luck and I hope you do better than King Canute.<br>
<br>
Alison Macfarlane<br>
<br>
-----Original Message-----<br>
From: A forum for discussion on midwifery and reproductive health research.<br>
</span></p><hr>
<p align="center">To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:<br>
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</p>
<p></p></div></div></div></div></blockquote></div></div>
</div>
<br>
<hr>
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</p>
--0000000000007373e905798620fd--
========================================================================Date: Wed, 31 Oct 2018 15:34:19 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
MacVane Phipps Fiona <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: MacVane Phipps Fiona <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: Claire Feeley <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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Claire
I know the write-up is a busy time but your work seems so timely that I would urge you to publish before, or along with the submission of your thesis, if you have not already done so. This does , of course, add credibility to your work as one of the things examiners look for is 'is this work of publishable quality'. Thanks for contributing to this very important discussion. You may have already selected examiners but if not, I am available to do external examination.
Best wishes,
Fiona
________________________________
From: A forum for discussion on midwifery and reproductive health research.
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========================================================================Date: Wed, 31 Oct 2018 16:19:29 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
MacVane Phipps Fiona <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: MacVane Phipps Fiona <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
Comments: To: Gillian Meldrum <[log in to unmask]>
In-Reply-To: <[log in to unmask]>
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I am very interested in being involved in any initiative for normal birth.
Fiona MacVane Phipps
________________________________
From: A forum for discussion on midwifery and reproductive health research.
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========================================================================Date: Wed, 31 Oct 2018 20:19:16 +0000
Reply-To: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>,
Claire Feeley <[log in to unmask]>
Sender: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
From: Claire Feeley <[log in to unmask]>
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018
(#2018-190)
In-Reply-To: <[log in to unmask]>
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Thank you Fiona, for both your words of encouragement and offer. I do have my examiner arranged, but thank you once again.
Best wishes Claire
On Wednesday, 31 October 2018, 15:34:31 GMT, MacVane Phipps Fiona <[log in to unmask]> wrote:
Claire
I know the write-up is a busy time but your work seems so timely that I would urge you to publish before, or along with the submission of your thesis, if you have not already done so. This does , of course, add credibility to your work as one of the things examiners look for is 'is this work of publishable quality'. Thanks for contributing to this very important discussion. You may have already selected examiners but if not, I am available to do external examination.
Best wishes,
Fiona
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From: A forum for discussion on midwifery and reproductive health research.
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<div>Thank you Fiona, for both your words of encouragement and offer. I do have my examiner arranged, but thank you once again.</div><div><br></div><div>Best wishes Claire </div><div><br></div>
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On Wednesday, 31 October 2018, 15:34:31 GMT, MacVane Phipps Fiona <[log in to unmask]> wrote:
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<div><div dir="ltr">Claire<br clear="none"><br clear="none">I know the write-up is a busy time but your work seems so timely that I would urge you to publish before, or along with the submission of your thesis, if you have not already done so. This does , of course, add credibility to your work as one of the things examiners look for is 'is this work of publishable quality'. Thanks for contributing to this very important discussion. You may have already selected examiners but if not, I am available to do external examination.<div class="ydp3e6ffe60yqt5924604238" id="ydp3e6ffe60yqtfd97475"><br clear="none"><br clear="none">Best wishes,<br clear="none"><br clear="none">Fiona<br clear="none"><br clear="none"><br clear="none">________________________________<br clear="none">From: A forum for discussion on midwifery and reproductive health research.<br clear="none">########################################################################<br clear="none"><br clear="none">To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:<br clear="none"><a shape="rect" href="https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1" rel="nofollow" target="_blank">https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1</a></div></div></div>
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