PURPOSE: This article examines maternal mortality in Uganda through the “Three Delays” framework. This framework asserts that maternal mortality in developing countries results from three delays to accessing appropriate health care: (a) the delay in making a timely decision to seek medical assistance, (b) the delay in reaching a health facility, and (c) the delay in provision of adequate care at a health facility.

STUDY DESIGN: This study provides a review and synthesis of literature published about maternal mortality, the “Three Delays” concept, Uganda, and sub-Saharan Africa between 1995 and 2010.

MAJOR FINDINGS: The “Three Delays” framework has relevance in the Ugandan context. This framework allows for an integrated and critical analysis of the interactions between cultural factors that contribute to the first delay and inadequate emergency obstetrical care related to the third delay.

MAJOR CONCLUSION: In order to reduce maternal mortality in Uganda, governments and institutions must become responsive to the cultural and health needs of women and their families. Initiatives that increase educational and financial status of women, antenatal care, and rates of institutional care may reduce maternal mortality in the long term. Improvements to emergency obstetrical services are likely to have the most significant impact in the short term.

This article describes the types of helpful and supportive interactions or communication strategies that characterize the collaborative relationships in which a midwife can engage across the novice-to-expert continuum of professional development. Similarities and distinctions are drawn between the various terms describing types of collaboration and discussed with respect to the added value that each relationship can have for the individual and for the health care team. A conceptual depiction of the essential components of effective teamwork or collaboration is presented. Emphasis is placed on the dynamic nature of the process of developing and sustaining these relationships across the midwife’s professional lifetime.

BACKGROUND: The issue of home birth has been examined in the medical and social sciences in relation to its biomedical safety and women’s birthing experiences. However, the role the home landscape itself plays at birth has only marginally been studied.

AIM: The objective of this study is to investigate the material and symbolic dimensions of the home environment, as experienced by women who gave birth at home in the Greek town of Volos in the period from 1994 to 2013.

METHODS: The biographical approach is adopted to study women’s birth narratives and their descriptions of the new uses of the home; the reflective position was used for the analysis of the findings.

FINDINGS: The narratives of the women on their expectations and experiences of birth at home included the issues of safety; privacy and intimacy; freedom, control, and responsibility; presence of the baby and close family members; the “naturalness” of birth; and the joy the new mothers experienced. The home territory was used in new, creative ways to facilitate the birth. The house itself underwent some provisional changes and was loaded with novel meanings.

CONCLUSION: Women were found to be empowered in their new role as mothers and as persons in general, and the home was redefined as a more open place that interacted with the public sphere.

Guatemalan maternal and infant mortality rates remain high, particularly among indigenous populations. In remote areas, traditional birth attendants (TBAs), without formal midwifery education, are frequently the only maternal care providers. We conducted a mixed methods study to evaluate knowledge, skills, and attitudes of 26 TBAs in western Guatemala. The purposes of this study were to evaluate the efficacy of a community-based midwifery training program and to determine how the knowledge, skills, and attitudes of TBAs influence the care provided to indigenous mothers and infants. Themes from 5 key informant interviews included survival of mother and baby, facilitating referrals, and community pressure not to refer. We offered a 2-week simulation-based training designed for low resource settings. Participants completed pre- and posttests and demonstrated midwifery skills. Knowledge scores and objectively measured skills improved significantly. Attitude outcomes included increased endorsement regarding importance of pre- and postnatal visits, recognizing risk/complications, and partnering with medical providers. Potential effects discussed include safe TBA practice, training value, and intent to disseminate learnings in their communities.

PURPOSE: Ankyloglossia (commonly referred to as tongue-tie), is increasingly being reported as a significant contributory factor to difficulties experienced in establishing the mother–infant breastfeeding relationship. Frenotomy as a management option is contributing to international interest and interdisciplinary controversy. The aim of this article was to identify and examine the evidence in relation to frenotomy to inform practice for newborns diagnosed with symptomatic ankyloglossia.

DESIGN: An integrated literature review, informed by Whittemore and Knafl (2005) was used to identify and evaluate contemporary evidence.

MAJOR FINDINGS: There is a marked difference in opinion between health disciplines regarding frenotomy as a treatment option for ankyloglossia. There is agreement that support from a trained professional such as a lactation consultant prior to undergoing any invasive procedures to treat ankyloglossia is essential. Controversy persists however as to whether the condition will resolve spontaneously without treatment.

CONCLUSION: Although frenotomy does seem to resolve breastfeeding difficulties, little is known regarding long-term consequences for the baby and optimal timing for the procedure. This review indicates a need for education of professionals and standardization of assessment processes along with ongoing research to identify efficacy and optimal timing of frenotomy when used.

AIM: To examine the contribution of the Virtual International Day of the Midwife (VIDM) conference to midwives’ continuing professional development (CPD).

BACKGROUND: Knowledge and understanding of CPD for midwives as synchronous online learning is limited. Studies of e-learning programs for CPD have underlined the need for interaction with others. The VIDM is a synchronous online 24-hour conference freely available for midwives designed to provide a unique CPD opportunity.

METHOD: An online survey with a mix of fixed-response, multiple-response, and open-ended free-text questions was available to participants for 1 month after the conference via the wiki page in 2012 and 2013.

FINDINGS: The survey was completed by 239 conference participants. Midwifery students and clinical midwives were the largest groups of attendees. The most common countries of residence were Australia, United Kingdom, and United States. Respondents believed that the conference contributed to their professional development by enabling professional growth, facilitating shared learning, and raising awareness of global issues.

CONCLUSION: Offering synchronous events is important to facilitate deeper learning for those engaging in online activities. As an annual synchronous 24-hour, open online conference, the VIDM has become a valuable CPD opportunity for midwives.

OBJECTIVE: To provide a critical and interpretive review of the literature to investigate examples of pain assessment tools used in a childbirth context. Through these examples of pain assessment, the concept of elicited verbal pain language is introduced and explored.

METHODS: Electronic search strategies were used to identify primary research regarding maternal reports of pain (during labor, postpartum and retrospectively), which were captured by standardized pain assessment tools.

FINDINGS: The review revealed the physiological (the sensory and affective dimensions of pain, the intensity of pain, and the influence of parity on pain perception), psychological (the influence of maternal attitude, mood, and memory on pain perception), and ethnocultural (the impact of the ethnocultural context on pain perception) components of the pain experience. The strengths and limitations of pain assessment tools are highlighted. There were similarities in the reviewed studies’ approaches to pain assessment despite the cross-cultural representation of birth. Possible implications for cross-cultural pain assessment and communication are outlined.

CONCLUSION: The question remains regarding the appropriateness of implementing standardized pain assessment tools across birth context. An ongoing critique of pain assessment may inform the provision of better care overall for birthing women in multicultural societies.