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Midwifery Dissertation Topics

Published by Owen Ingram at January 3rd, 2023 , Revised On August 16, 2023

There have been midwives around for decades now. The role of midwives has not changed much with the advent of modern medicine, but their core function remains the same – to provide care and comfort to pregnant women during childbirth.

It is possible to be a midwife in the healthcare industry, but it is not always a rewarding or challenging career. Here are five things you didn’t know about midwifery nursing to help you decide if it could be the right career choice for you.

The profession of midwifery involves caring for women and newborns during pregnancy, childbirth, and the first few days following birth. Registered nurses are trained with four additional years of education along with major research on methods involve in midwifery and writing on midwifery dissertation topics, while midwives provide natural health care for mothers and children.

As a midwife, your role is to promote healthy pregnancies and births while respecting women’s rights and dignity. Midwives provide care to patients at every stage of life, from preconception to postpartum, family planning to home delivery to breastfeeding support.

Important Links: Child Health Nursing Dissertation Topics , Adult Nursing Topics , Critical Care Nursing Dissertation Topics . These links will help you to get a broad experience or knowledge about the latest trends and practices in academics.

Midwifery Is A Good Fit for the Following:

● Those who want to work with women, especially those at risk of giving birth in a hospital setting. ● Those who enjoy helping people and solving problems. ● Those who like to be creative and solve complex problems. ● Those who want to help others and make a difference in their lives.

Midwifery is a career with many benefits for both the midwife and the baby. They are well-trained and experienced in caring for pregnant women and newborns and often have access to the exceptional care that other nurses may not have.

Midwifery Dissertation Topics With Research Aim

Topic:1 adolescence care.

Research Aim: Focus on comprehensive medical, psychological, physical, and mental health assessments to provide a better quality of care to patients.

Topic:2 Alcohol Abuse

Reseasrch Aim: Closely studying different addictions and their treatments to break the habit of drug consumption among individuals.

Topic:3 Birth Planning

Research Aim: Comprehensive birth planning between parents discussing the possible consequences of before, between, and after labour.

Topic:4 Community midwifery

Research Aim: Studying different characters in community midwifery and the midwife’s role in providing care for the infant during the early days of the child’s birth.

Topic:5 Contraception

Research Aim: Understand the simplicity of contraception to prevent pregnancy by stopping egg production that results in the fertilization of egg and sperm in the later stages.

Topic:6 Electronic fetal monitoring

Research Aim: In-depth study of electronic fetal monitoring to track the health of your baby during the womb, record construction per minute, and make a count of your baby’s heart rate.

Topic:7 Family planning

Research Aim: Importance to follow the basic rhythm methods for the couple to prevent pregnancy and use protection during the vaginal sex to plan a family without fertility treatments.

Topic:8 Foetal and newborn care

Research Aim: Expansion of the maternal-fetal and newborn care services to improve the nutritional quality of infants after delivery during their postnatal care time.

Topic:9 Foetal well being

Carefully tracking indications for the rise in heart rate of the fetal by weekly checkups to assess the overall well-being of the fetal.

Topic:10 Gender-based violence

Research Aim: Studying the consequences of male desire for a child that results in gender-based violence, harming the child’s physical and mental health.

Topic:11 Health promotion

Research Aim: Working on practices that help in controlling the amount of pollution of people, taking care of their overall health, and improving quality of life through adapting best health practices.

Topic:12 High-risk pregnancy

Research Aim: Calculating the ordinary risks of a high-risk pregnancy and how it affects a pregnant body resulting in a baby with poor health or any by-birth diseases, increasing the chance for complications.

Topic:13 HIV infection

Research Aim: Common causes of HIV infection and their long-term consequences on the body’s immune system. An in-depth study into the acquired immunodeficiency and the results leading to this.

Topic:14 Human Rights

Creating reports on human rights and their link with the freedom of thought, conscience, religion, belief, and other factors.

Topic:15 Infection prevention and control

Research Aim: Practices for infection prevention and control using efficient approaches for patients and health workers to avoid harmful substances in the environment.

Topic:16 Infertility and pregnancy

Research Aim: Evaluating the percentage of infertility and pregnancy, especially those facing no prior births, and who have high chances of infertility and pregnancy complications.

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Midwives are nurses who provide continuous support to the mother before, during, and after labour. Midwives also help with newborn care and educate parents on how to care for their children.

How Much Do Midwives Make?

The salary of a midwife varies depending on the type of work, location, and experience of the midwife. Midwives generally earn $132,950 per year. The average annual salary for entry-level midwives is $102,390.

The minimum requirement for becoming a midwifery nurse is a bachelor’s degree in nursing, with the option of pursuing a master’s degree.

An accredited educational exam can also lead to certification as a nurse-midwife (CNM). The American College of Nurse-Midwives (ACNM) enables you to practice independently as a midwife.

There are many pros and cons to working as a midwife. As a midwife, you have the following pros and cons:

Midwives have the opportunity to help women during one of the most memorable moments in their lives.
Midwives can positively impact the health of mothers and their children.
Midwives can work in many hospitals, clinics, and homes.
In midwifery, there are many opportunities for continuing education and professional development.
You will often have to work nights and weekends, which can be mentally draining.
You will have to travel a lot since most births occur in hospitals or centres in different areas.
You will have to deal with stressors such as complex patients and uncooperative families.
You will be dealing with a lot of pain, so you need to be able to handle it without medication or other treatment methods.

A career in midwifery is a great fit for those with a passion for health and wellness, an interest in helping people, and a desire to work in a supportive environment.

It is important to become involved in your local midwifery community if you are contemplating a career in midwifery – the best source of learning is your major research work, along with writing a lengthy thesis document on midwifery dissertation topics that will submit to your university to progress your midwifery career.

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How to find midwifery dissertation topics.

To find midwifery dissertation topics:

Explore childbirth challenges or trends.
Investigate maternal and infant health.
Consider cultural or ethical aspects.
Review recent research in midwifery.
Focus on gaps in knowledge.
Choose a topic that resonates with your passion and career goals.

Midwifery Dissertation Topics List (30 Examples) For Your Research

Mark Dec 14, 2019 Jun 5, 2020 Midwifery , Nursing No Comments

As a student, if you are finding Midwifery dissertation topics, you have visited the right site. We offer a wide range of midwifery dissertation topics and project topics on midwifery. As the field has evolved, the research topics on midwifery are based on new and emerging concepts and ideas. You can choose any of the […]

As a student, if you are finding midwifery dissertation topics, you have visited the right site. We offer a wide range of midwifery dissertation topics and project topics on midwifery. As the field has evolved, the research topics on midwifery are based on the new and emerging concepts and ideas.

You can choose any of the give topic for your research in midvfery and our team can offer quality dissertations according to your requirements.

A list Of midwifery dissertaton topics

Emerging trends in midwifery and obstetrical nursing.

Modern trends of the N education in midwives and modern methods in practical training.

The impact of delayed umbilical cord clamping after birth.

How the cell-free DNA screening is helpful in identifying genetic problems in the baby?

Limiting interventions during low-risk labor.

The concept of cost containment in healthcare deliver.

The importance of family centred care and natural childbirth environment.

An interpretive research on the disparity between women’s expectations and experience during childbirth.

Systematic literature review on the extrauterine life management focusing on lung functions in new born.

To analyse the role of perinatal care to pregnant women.

Studying the treatment alternatives for urogenital infections in rural women.

Conducting a systematic review on how midwifery students plan their career.

Strategies adopted by midwives to advise pregnant women about nutritional values and healthy food consumption.

Studying the impact of Hepatitis B in pregnant women.

Analysing how frequent miscarriages are linked with higher anticardiolip antibodies.

Studying the relationship between perinatal mortality rates and physical activity levels.

How can nurses recommend preventive strategies to avoid sexual transmission of Zika virus to new born?

Evaluating the attitude of women related to the implementation of basic immunisation programs in village.

Analysing the modern trends of the education in midwives and new methods in practical training.

To study the advance trends in gynaecology and obstetrics.

The role of midwives in saving the lives of unborn foetus.

Exploring the global trends in nursing and midwifery education.

Analysing the role of optimal midwifery decision-making during second-stage labour.

To study the integration of clinical reasoning into midwifery practice.

A literature review on labouring in water.

Exploring the experiences of mothers in caring for children with complex needs.

An ethnography of independent midwifery in Asian countries.

To explore the perceptions of control in midwifery assisted childbirth.

Analysing the decision-making between nurse-midwives and clients regarding the formulation of a birth plan.

The role of Vitamin D supplementation during pregnancy .

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Doctoral Thesis Collection

This midwifery PhD thesis collection is an exciting new initiative for the RCM.

The aim of the collection is to provide a platform for midwives to showcase their academic work, and to inspire and support midwives who are considering or who are currently undertaking further academic study. Additionally, the collection will provide a source of open access midwifery generated evidence for everyone to use.

The opportunity for midwives to include details of the resultant publications and their social media details and institutional link, if appropriate will hopefully also support the creation of professional networks related to their academic interests. Authors may have also published articles from their thesis, so please use an author’s contact details to ask about this.

If you are a midwife and have a completed a PhD and would like to include your thesis in this collection, please complete the online form below.

If you would like to search the Thesis Collection, "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. Pressing the Ctrl/Command key + the F key will bring up a search box in the top right corner of your screen. You can then use this to search the Collection for keywords.

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Published: 19 June 2018

Midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth

Lucy Lewis 1 , 2 ,
Yvonne L. Hauck 1 , 2 ,
Janice Butt 2 ,
Chloe Western 2 ,
Helen Overing 2 ,
Corrinne Poletti 2 ,
Jessica Priest 2 ,
Dawn Hudd 3 &
Brooke Thomson 1

BMC Pregnancy and Childbirth volume 18 , Article number: 249 ( 2018 ) Cite this article

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There is limited research examining midwives' education, knowledge and practice around immersion in water for labour or birth. Our aim was to address this gap in evidence and build knowledge around this important topic.

This mixed method study was performed in two phases, between August and December 2016, in the birth centre of a tertiary public maternity hospital in Western Australia. Phase one utilised a cross sectional design to examine perceptions of education, knowledge and practice around immersion in water for labour or birth through a questionnaire. Phase two employed a qualitative descriptive design and focus groups to explore what midwives enjoyed about caring for women who labour or birth in water and the challenges midwives experienced with waterbirth. Frequency distributions were employed for quantitative data. Thematic analysis was undertaken to extract common themes from focus group transcripts.

The majority (85%; 29 of 34) of midwives surveyed returned a questionnaire. Results from phase one confirmed that following training, 93% (27 of 29) of midwives felt equipped to facilitate waterbirth and the mean waterbirths required to facilitate confidence was seven. Midwives were confident caring for women in water during the first, second and third stage of labour and enjoyed facilitating water immersion for labour and birth. Finally, responses to labour and birth scenarios indicated midwives were practicing according to state-wide clinical guidance.

Phase two included two focus groups of seven and five midwives. Exploration of what midwives enjoyed about caring for women who used water immersion revealed three themes: instinctive birthing; woman-centred atmosphere; and undisturbed space. Exploration of the challenges experienced with waterbirth revealed two themes: learning through reflection and facilities required to support waterbirth.

Conclusions

Peer Review reports

The provision of water immersion for labour and birth is facilitated by midwives working within low risk midwifery-led models of care who are deemed competent to provide this method of birth [ 1 , 2 ]. The concept of competence is often aligned with confidence [ 3 ], but distinguishing between these two concepts is important as they are not always synonymous. A midwife may be a competent waterbirth practitioner having met all the professional competency requirements, but becoming confident is an individual journey that is dependent upon trust in clinical guidelines, presence of peer support and the challenge of achieving consistent exposure to waterbirth [ 4 ]. Additionally, midwives with extensive experience of conventional birth on land may be challenged to unlearn old skills and develop new practices required for water immersion in labour and birth. Whilst midwives working within low risk continuity of care models where physiological birth was the norm, researchers concluded that a supportive culture assisted in the development of their confidence, irrespective of clinical experience [ 4 ].

Individual midwives can act as gate keepers to water immersion which is more likely to be accepted into an organisation’s culture when it is supported by midwifery managers and championed by experienced waterbirth practitioners [ 5 ]. These champions can mentor midwives who wish to achieve waterbirth competency [ 5 ]. In this situation, mentors may not always be the most senior midwives who have extensive experience with conventional birth on land. Caution is recommended to recognise and consider ways to minimise the possible hierarchical tensions that may occur when experienced midwives are mentored by junior midwives who have achieved waterbirth competency [ 4 ]. Indeed, promoting and sustaining change in midwives’ waterbirth practice can be challenging. A study, undertaken in the United Kingdom (UK), utilised problem solving workshops to identify interventions that could develop and sustain a waterbirth culture. These interventions included: publishing monthly waterbirth statistics; setting a target of 100 waterbirths per annum; keeping portable birthing pools partially inflated; and appointing a waterbirth champion. Co-ordinators were able to positively influence midwifery practice through social support which was found to be pivotal in relation to developing and sustaining a waterbirth culture [ 6 ].

Access to immersion in water for labour and birth is reliant on both the care provider and the policies and procedures that guide clinical practice. Policies and guidelines in relation to water immersion for birth in Australia usually reflect the organisation’s interpretation of the current literature [ 7 ]. Additionally, more evidence is required around the effect of immersion in water on neonatal morbidity [ 1 , 8 , 9 ] and management of the third stage of labour [ 7 ]. A literature review exploring midwives concerns around waterbirth [ 10 ] identified three clinical issues (neonatal water aspiration and neonatal and maternal infection and thermo-regulation) and two practice issues (midwives skills and education and emergency procedures around maternal collapse). The clinical issues were not evidence based and the practice issues could ‘be addressed by appropriate policy, guidelines and practice’ [ 10 ]. Other work exploring how a convenience sample of 249 Australian midwives utilised normal birth guidelines, found that although the majority (90%) were aware that specific guidelines existed, only 71% reported routinely using them to guide their clinical practice [ 11 ].

It has been suggested that the waterbirth environment nurtures woman-centred care by facilitating shared decision making and perceptions of control around their care [ 8 ]. However, recent Australian research found some midwives perceive waterbirth policies and guidelines can limit their scope to facilitate water immersion and did not always support women’s informed choice [ 12 ].

There is limited research examining midwives' education, knowledge and practice around immersion in water for labour or birth. To address this gap in evidence and build our knowledge around this topic, our intention was to obtain a contemporary overview of midwives' experience of their education, knowledge and practice around immersion in water for labour or birth in Western Australia (WA).

The specific aim of this WA study was to assess Midwifery Group Practice (MGP) and Community Midwifery Program (CMP) midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth. This mixed method study was performed in two sequential phases. Phase one incorporated a cross sectional design and examined midwives' perceptions of education, knowledge and practice around immersion in water for labour or birth through a questionnaire; 34 midwives were invited to participate. Phase two employed a qualitative descriptive design to explore what midwives enjoyed about caring for women who labour or birth in water and the challenges midwives experienced with waterbirth; two focus groups were held.

Mixed methods were utilised to provide in-depth knowledge [ 13 , 14 ] relating to the education, knowledge and practice around immersion in water for labour or birth. This methodology offers researchers using quantitative methods the opportunity to utilise qualitative research to gain deeper understanding of the investigated phenomenon [ 15 ]. Utilising this two phase mixed methodology provided a more informative, constructive and thorough integration of the research results, building on the links between methods rather than within methods [ 15 ]. We envisaged being able to utilise both numbers and words would give greater insight into the bigger picture around midwives' experience of their education, knowledge and practice around immersion in water for labour or birth.

Participants and setting

The study was performed at the sole tertiary public maternity hospital in WA, which has approximately 5200 births annually. Women can labour and birth in the tertiary maternity hospital’s Labour Ward and Birth Suite or the Family Birth Centre (an adjacent building within the hospital grounds).

Perinatal data collected in 2016, by King Edward Memorial Hospital (KEMH) in WA confirmed that 5% (228 of 4402) of infants ≥37 weeks gestation were born immersed in water. Currently WA and South Australia are the only Australian states with state-wide policies and guidance supporting immersion in water for labour and birth, although waterbirth is available in every state and territory [ 16 , 17 ]. In WA midwives are guided by state-wide clinical waterbirth guidelines [ 16 ]. Between August and November 2016 we invited the 34 midwives who provided care for women who opted to use water for labour and/or birth to participate. Throughout the study, women choosing to labour and/or birth in water were cared for by midwives working within two publically funded services: the MGP and CMP. These low risk continuity of care models [ 18 ] are ideally suited to provide care for women who labour and/or birth in water, as this model facilitates a shift from high risk obstetric-led care to low risk midwifery-led care [ 18 , 19 ]. Both the MGP and CMP operate their services (antenatal, intrapartum and postnatal care) from the Family Birth Centre (FBC) with the CMP also providing antenatal, intrapartum and postnatal care to women in their homes and local community clinics. In these midwifery care models, a primary midwife is supported by a small team of midwives who provide continuity of care 24 h a day throughout pregnancy, birth and up to two weeks post birth. Perinatal data collected in 2016 at KEMH confirmed MGP and CMP midwives birthed 16% (813 of 5189) of all women at KEMH. Although, no women received immersion in water for labour and birth in the tertiary maternity hospital’s Labour Ward and Birth Suite throughout the duration of the study, in the last two weeks of the study the tertiary maternity hospital agreed that immersion in water for labour and birth could be facilitated in their main Labour and Birth Suite.

Recruitment and data collection

Midwives were invited to participate in the study through an information letter and in-house designed questionnaire (Additional file 1 ), both of which were sent to their workplace mobile phone. Midwives who did not want to complete the online questionnaire were given the option to complete a hard copy and return it to the research team by placing it in a locked box situated in the FBC. Returning a completed questionnaire was deemed implied consent. Ethics approval was gained from the Women and Newborn Health Service Ethics Committee (Approval Number 2016103QK) at the study centre.

The questionnaire was validated through a review process with an expert panel involving a midwifery educator and three midwives who had experience caring for women who had birthed in water. Feedback from the panel resulted in changes to questions around being competent to facilitate water immersion for labour or birth and actively promoting this birth choice for labour and birth. This question was divided into two questions, one focused upon labour and another concerning birth.

The aim of the questionnaire was to examine midwives' perceptions of education, knowledge and practice around immersion in water for labour. Midwives were asked about: their employment status (if they worked in the MGP or CMP and how long they had been working as a midwife and facilitating water immersion for labour or birth); their education (training undertaken to facilitate immersion in water for labour or birth and number of births required to develop waterbirth confidence); their practice (two factors they would discuss with women in relation to water immersion for labour or birth); their confidence caring for women immersed in water for labour and birth (in the first, second and third stages of labour); their enjoyment facilitating immersion in water for labour and birth; whether they actively promote water immersion for labour and birth; and their interpretation of four scenarios around antenatal, early labour, birth and third stage clinical care. The scenarios required a written response, were scored and were based on information relating to the state-wide clinical waterbirth guidelines [ 16 ]. It was decided to give midwives completing the questionnaire a website link to the state-wide guidelines [ 16 ], in the information letter accompanying the questionnaire. By providing a website link to this guidance, we were examining how midwives interpreted and applied the guidance in their clinical practice. In relation to confidence and enjoyment, midwives were asked to place a cross on a 10 cm line (where zero was ‘not confident’ or ‘does not enjoy’ and 10 was ‘very confident’ or ‘enjoys’), to quantify their perceptions on the continuum from zero to ten.

An item was included at the end of the questionnaire (phase one) inviting midwives to participate in a focus group to discuss their experiences around immersion in water for labour or birth. The first author conducted the two focus groups. Observations were documented by the fourth author in the form of field notes. Each focus group lasted approximately 45 min. The focus groups were held at the study centre in an interview room that was convenient to all interested midwives. Prior to commencing the focus group, midwives were reminded that their privacy would be maintained by issuing each of them a unique identifier; the discussions linked to an individual’s identity should ‘remain in the room’; and that the focus group would be audio recorded. All midwives verbally consented to these conditions.

The final questions for the focus groups (Additional file 2 ) were based around the results from phase one, with two questions being developed: question one asked ‘What contributes to your enjoyment of waterbirth?’ Two prompts were utilised for this question. The first one addressed the promotion of natural birth and the second was around supporting women’s choice. Question two asked ‘Are there any issues with waterbirth?’ One prompt was utilised around the issue of exploring which stage of labour midwives found most challenging.

Data analysis

Phase one: quantitative data.

Each of the four clinical scenarios was allocated a maximum score according to whether a midwife correctly identified key aspects of clinical practice based on the state-wide clinical waterbirth guidelines [ 16 ]. Four members of the research team independently scored each scenario. The team then met to compare scores. Any disagreement in relation to the scores was discussed and a consensus reached by referring back to the data.

Means, and interquartile ranges were used to summarise continuous data (such as the scores for each scenario). Frequency distributions were used to summarise categorical data (such as feeling equipped to facilitate waterbirth following training). Statistical software (SPSS version 22) was used for analysis.

Phase two: Qualitative data

Transcribed focus groups were subjected to thematic analysis [ 20 ] by five members of the research team, who analysed a cross-section of transcripts and field notes ensuring each data source was reviewed by at least two members [ 21 ]. Analysis required the research team to become submerged in the data. Transcripts and field notes were deconstructed enabling the research team to identify patterns, similarities and themes from the midwives’ words or sentences [ 13 , 20 , 21 ]. The team met weekly over three months to negotiate, clarify and refine the themes. Any disagreements on interpretation were negotiated by referring back to the data. All the researchers were clinical or academic midwives, with varying experiences of facilitating immersion in water for labour or birth. As a process of member checking, preliminary themes were presented to five midwife participants who confirmed agreement with the themes.

Table 1 summarises the midwives’ perception of their education, knowledge and practice around immersion in water for labour and birth. A total of 29 (85%) out of a potential 34 midwives returned a questionnaire. The mean time midwives were qualified was 162 months (13 years and 5 months), with the mean time midwives had been facilitating waterbirth being 83 months (eight years and 9 months). Most (59%; n = 17) midwives worked in the MGP. The majority (93%; n = 27) of midwives used the WA state-wide clinical guidelines for waterbirth [ 16 ] for their education and training, with 90% ( n = 26) accessing the E-learning package developed by the study hospital’s education department. Following waterbirth training, 93% ( n = 27) felt equipped to facilitate waterbirth with the mean number of waterbirths required to facilitate confidence being seven.

On a scale of 0 to 10 (where zero was ‘not confident’ and 10 was ‘very confident’), midwives were very confident caring for women in water during the first stage of labour (mean score of 10). They were also confident caring for women in the second stage (mean score of 9) and third stage of labour (mean score of 8). The mean score in relation to confidence using the emergency evacuation to get the woman out of the bath was eight. On a scale of 0 to 10 (where zero was ‘does not enjoy’ and 10 was ‘enjoys’), midwives enjoyed facilitating immersion in water and birth, obtaining a mean score of 10. Finally, mean scores for the antenatal, early labour, birth and third stage of labour scenarios indicated midwives were practicing according to the WA state-wide clinical guidelines for waterbirth [ 16 ].

Two focus groups comprising of seven and five midwives were performed. Findings are presented with supportive quotes in italics from the midwives. For confidentiality a pseudo-name was allocated to each midwife.

Caring for women who labour or birth in water

Exploration of what midwives enjoyed about caring for women who labour or birth in water revealed three distinctive themes: instinctive birthing; woman-centred atmosphere; and undisturbed space (Table 2 ).

Instinctive birthing

The theme ‘instinctive birthing’ described how midwives perceived labouring or birthing in water nurtured an instinctive birthing behaviour led by the woman. Anna reflected ‘ You absolutely see the hormones that promote labour take over. You know labour progresses better and the woman relaxes into labour ’. Noreen agreed; they ‘ Really feel what the body is able to do and how birth feels ’, whilst Kate described how she perceived water enabled her to trust a woman’s ability to instinctively birth:

I think they progress really well. I don’t do many vaginal exams, but they are getting in [the water] and they are well established, they are fully before you know it and they don’t push early. Like sometimes with their first grunt the heads on view…They’re not asking for epidurals, they’re not asking for gas.

Jasmine agreed with Kate’s sentiments: ‘ Because you can’t see as the vagina is submerged, the first sign she needs to push is she’s pushing ’ whilst Anna summarised her experience was that ‘ They’re more likely to reach down and lift the baby up themselves ’.

Woman-centred atmosphere

The theme ‘woman-centred atmosphere’ described a labour and birth environment which was woman centred, calm, peaceful and relaxed. Initially midwives discussed how labouring and birthing in water empowered women. Jacquie noted ‘ I feel women have more control ’. Anna agreed suggesting she thought it was to do with power stating ‘ The woman holds more of the power in labour ’. Noreen continued the discussion ‘ the thing is society brings up pictures of women with somebody doing it [the birth] for them, there is a cultural thing of having somebody delivering the baby whilst [with water] there is themselves and their body ’. Bonnie reflected on Noreen’s comments suggesting water promoted a change in the woman’s demeanour ‘ You can see the change in the woman’s face and in her body when she gets in the water, it’s nice and relaxed ’. Beth agreed water ‘ Promotes the environment to be quiet and peaceful ’. Jacquie thought this may be because ‘ The space between contractions is very different from a land birth, they are very much more focused on their breathing and calmer ’. Whilst Noreen shared how a woman’s relaxed state affected the care she gave ‘ You know it’s all relaxed and you can concentrate more on the signs, the natural signs of a woman giving birth ’ . Sophie agreed ‘ It’s so calming for the women. I think it relaxes them which then relaxes us ’.

Undisturbed space

The theme ‘undisturbed space’, described how water creates an undisturbed space where access to the woman is mediated by the water. Jasmine noted that ‘ If you’re in the bath people knock and they stay out, they leave you alone. As far as society is concerned, it’s not acceptable to walk into the room when someone’s in the bath. If someone’s in lithotomy, fine ’. Kerry reflected it also had an impact on how safe the woman felt. ‘ Especially for the women who have a sexual abuse history, they feel safer in the water, they feel like you can’t get at them ’. The topic of safety led to a discussion around privacy with Olivia commenting that ‘ It’s [‘water] their ‘own space and you have to really reach into their space, rather than them being poked and prodded [with a land birth]’. Dorothy agreed stating ‘ It’s more undisturbed ’. Kerry continued ‘ Even though you can see beneath the water and everything, I think for them it just feels, more private under the water ’. Kate reflected on her experiences by recounting a scenario ‘ A woman that came back to the waterbirth study day and spoke about when she got in [the pool] there was a real sense of privacy, even though she had nothing on, the water was like a veil ’. Baily also remarked on how the ‘dynamics’ of a labour in water effects the partner ‘ I get a sense they quite like it too, because they are able to just sit and observe and hold that silent still place…my experience is that even men feel quite comfortable in that space ’.

The challenges midwives experienced with waterbirth

Analysis of the focus group transcripts exploring the question ‘are there any issues with waterbirth’ revealed that issues highlighted by the midwives were perceived as challenges. Two themes were identified: learning through reflection and facilities required to support waterbirth.

Learning through reflection

The theme ‘learning through reflection’ illustrates how midwives learnt by documenting and then reflecting on the clinical challenges encountered during their day to day clinical practice around water immersion for labour and birth. Kerry shared ‘ I didn’t used to but since we’ve been doing group practice… when you look at your records you can see most of them are waterbirths ’. Olivia continued ‘ I don’t remember all of the waterbirths…I’ve got a little book that I just pop them in ’. Kate reflected on her colleagues comments sharing she did not keep records of each waterbirth and that her confidence caring for women in water ‘ took a long time. I’ve probably done, I don’t know over 150 now ’. Kate went on to explain why ‘ You had to flex the head and then move the hand and then sweep the perineum, it was really hands on. But that’s how we were taught. So to move to totally hands off [waterbirth] where you’re not even poised is challenging ’. Olivia agreed with Kate’s sentiments describing a waterbirth scenario where ‘ I remember taking over from somebody else and it was a hypno-birth and so there was no talking…it was a good learning experience ’.

To illustrate, the topic of learning through clinical experience led to a discussion around placental cord snapping. Bonnie shared ‘ I’ve had a few cord snaps now. Like quite a few issues, but it hasn’t changed my feeling of how to perform waterbirth because I know it’s going to be fine and we just deal with it as it comes ’. Kerry empathised, supporting Bonnie by acknowledging ‘ I think a lot of midwives get anxious even though they may pretend they don’t get anxious about waterbirths. They want to get the baby out as fast as possible. But I think if you make them [the women] aware you don’t just yank it [the baby up]… you need to check how long it [the cord] is before you can go yanking’ .

Facilities required to support waterbirth

The theme ‘facilities required to support waterbirth’ related to ensuring waterbirth facilities were suitable, available and accessible for women and identified challenges relating to the provision of infrastructure around waterbirth. Jasmine stated:

If we want this option [waterbirth] open for all women then we need to provide the facilities for that to happen. I have an issue with it being inequitable at the moment. The Birth Centre has the birth pool and blow up pools that are free of charge whilst clients [women] in the main hospital and CMP have to pay and hire their own…how come one group of clients under the same public system get it for nothing and the other group have to pay?

Sophie was also concerned by the rollout of waterbirths to the main hospital but her frustration was around the referral process. ‘ When waterbith was approved in the main hospital…I had a patient come over and say ‘I want a waterbirth but they [the main hospital] won’t facilitate one for me over there and they’ve told me to come to the Birth Centre and I was quite surprised ’. Whilst Kate’s sentiments concerned the content of the waterbirth guidelines. ‘ When it [the waterbirth guideline] was first developed we didn’t have telemetry and now we do. So I think waterbirth telemetry needs to be incorporated into the guideline’ . Other midwives did not appear sure of how often in-service needed to be provided in relation to emergency management, pool evacuation and assessment of blood loss. There was debate between midwives in relation to how often these drills should be performed. Dorothy confirmed ‘ In the CMP we have to do like a quiz, you know we put the blood in the water every six months and estimate it ’. Whilst Jacquie confirmed ‘ We do up a calendar [of available professional development sessions]’ and it was up to individuals to ensure their development was up to date.

This mixed methods study enabled us to explore midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth in WA. Quantitative analysis found the majority of midwives felt equipped following waterbirth training to facilitate labour and birth in water, with scenario responses indicating midwives were practicing according to the WA state-wide guidance. Additionally, midwives were confident and enjoyed caring for women who used water immersion. Qualitative exploration of what midwives enjoyed about caring for women who used water immersion for labour and/or birth revealed three distinctive themes: instinctive birthing; woman-centred atmosphere; and undisturbed space. Whilst exploration of the challenges experienced with waterbirth revealed two themes: learning through reflection and facilities required to support waterbirth. Our discussion will focus on what waterbirth offers midwives.

Labouring and birthing in water is centred around the philosophy that pregnancy and birth are normal life events [ 19 ]. The importance of sustaining a waterbirth culture highlighted by these WA midwives aligns with the belief that maintaining low risk birth cultures is essential to meet the needs of healthy, low risk women through recognition and respect of midwives’ contribution [ 22 ]. Midwives in this study were experts in their field, who had been qualified for a mean of 13 years and five months and facilitating waterbirth for a mean of eight years and nine months; similar to other research [ 6 ]. During the study it was agreed that immersion in water for labour and birth could be facilitated in the tertiary Labour and Birth Suite. We suggest this expertise will be integral in relation to supporting midwives in the tertiary Labour and Birth Suite to become skilled waterbirth practitioners. Indeed, an action research study introducing a problem solving waterbirth workshop with UK midwives and their co-ordinators positively affected change in waterbirth practice and was recognised for its potential shift toward normalising low risk midwifery care [ 6 ].

Midwives are guided by the International Confederation of Midwives (ICM) Position Statement on ‘keeping birth normal’ [ 23 ] which asserts that midwives are advocates and experts in low risk childbirth. The ICM acknowledges that ‘women should have access to midwifery-led care, one-to-one support, including the choice of a home birth and immersion in water’ [ 23 ] which aligns with the international recommended pathway towards evidence based respectful maternity care [ 24 ]. Utilising immersion for labour and/or birth provides midwives with an opportunity to facilitate this experience for women.

The theme of ‘learning through reflection’ articulated by the midwives supports the ICM Philosophy of Midwifery Care [ 25 ] ensuring competent midwifery care is informed and guided by continuous education. The association between workplace learning and competence was confirmed in a Japanese study with nurse/midwives who related learning through reflection to their self-reported competence [ 26 ]. Differences were noted based upon level of experience whereby learning from feedback and training were associated with competence for more experienced clinicians compared to learning through practice and from others for self-reported competence for those with less experience [ 26 ]. Fittingly, the Australian national competency standards for the midwife [ 27 ] present domains around the provision of woman-centred care, with one domain suitably entitled ‘reflective and ethical practice’. Midwives in this study reinforce the relevance of this domain in their practice as both the clinical scenarios and focus group findings illustrated they valued having the ability and skills to analyse and reflect in, on and about practice to ultimately maintain clinical competence and confidence. In short, when care is provided by midwives who are educated [ 28 , 29 ], regulated [ 21 , 30 ] and provide respectful evidence based care [ 24 ], the outcomes are improved for women and their infants [ 1 , 24 , 28 , 29 ]. The midwives in this study adhered to these principles empowering women to realise their potential to birth, though the medium of water.

Strengths and limitations

Although the quantitative methods employed provided limited scope to explore the wide range of experiences midwives in our study encountered caring for women who laboured and/or birthed in water, they did provide the research team with an objective starting point for further exploration of specific aspects of the questionnaire [ 21 , 30 ]. For example, utilising a question for the focus groups gleaned from a phase one question asking midwives to score their enjoyment facilitating immersion in water for labour and birth, gave us the opportunity to contextualise what they enjoyed; providing a connection between the quantitative and qualitative components that could not be answered by mono-methods alone. By utilising both numbers and words to explore this topic [ 14 , 15 ], the qualitative and quantitative components became cohesively integrated, producing research findings around midwives enjoyment which were greater than the sum of individual parts of the research [ 31 ]. This approach exposed the importance of instinctive birthing; woman-centred atmosphere; and undisturbed space.

Midwives in this study were self-selected from the MGP and CMP midwives based within the sole tertiary public maternity hospital in WA. Providing midwives with a website link to the WA state-wide waterbirth guidelines may have influenced their responses. This was a self-assessment of competence which is a subjective aptitude. The research would have been strengthened by comparing the midwives responses to their actions. Participating midwives may have been motivated and confident in their waterbirth practice. The sample of midwives included in phase one was small and may not be representative of all midwives who provide care for women who labour and/or birth in water. We acknowledge these factors could have had an impact in relation to the findings and should be considered when interpreting transferability of the findings to other settings.

This research contributes to the growing knowledge base examining midwives' education, knowledge and practice around immersion in water for labour or birth. It also highlights the importance of exploring what immersion in water for labour and birth offers midwives, as this research suggests they are an integral component in relation to supporting and sustaining a waterbirth culture. Midwives in this WA study were both competent and confident and enjoyed caring for women who used water immersion. Perhaps this was because the medium of water not only empowered women to realise their potential, but also themselves.

Abbreviations

Community Midwifery Program

Family Birth Centre

International Confederation of Midwives

King Edward Memorial Hospital

Midwifery Group Practice

United Kindgom

Western Australia

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Acknowledgements

We would like to thank King Edward Memorial Hospital for providing funding for the research staff and the midwives for graciously sharing their experiences.

The research was not supported by a research grant. King Edward Memorial Hospital provided funding for the research staff to undertake and complete the project with no role in study design, data collection, analysis, interpretation and writing the manuscript.

Availability of data and materials

We had assured the midwives participating in the study we would maintain their confidentiality and privacy. As there 29 midwives in this study, we were not able to make their supporting data available as we felt their identity may be compromised.

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School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia, 6102, Australia

Lucy Lewis, Yvonne L. Hauck & Brooke Thomson

Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, 6008, Australia

Lucy Lewis, Yvonne L. Hauck, Janice Butt, Chloe Western, Helen Overing, Corrinne Poletti & Jessica Priest

Family Birth Centre, Midwifery Group Practice and Community Midwifery Program, King Edward Memorial Hospital, Subiaco, 6008, Western Australia, Australia

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Contributions

All authors read and approved the final version of the manuscript. LL was responsible for the proposal, ethics approval development of the data collection tool/questions and coordination of the study. For the quantitative data she assisted data entry into SPSS. She also performed the quantitative data analysis. For the qualitative data she ran the focus groups and participated in thematic analysis. She drafted the article and was responsible for the final editing which incorporated the team member’s comments. YH assisted LL with the proposal and ethics approval and development of the data collection tool. For the qualitative data she participated in the thematic analysis. She assisted LL with the drafting of the article. JB assisted with development of the data collection tool/questions and made comments on the final article. CW assisted with the coordination of the study. For the qualitative data she assisted with the focus groups. She made comment on the final article. HO participated in thematic analysis. She made comment on the final article. CP participated in thematic analysis. She made comment on the final article. JP participated in thematic analysis. She made comment on the final article. DH assisted with coordination of the study. She made comment on the final article. BT contributed and approved the final article.

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Correspondence to Lucy Lewis .

Ethics declarations

Ethics approval and consent to participate.

Ethics approval was gained from the Women and Newborn Ethics Committee (Approval Number 2016103QK) at the study centre. Returning a completed questionnaire was deemed implied consent. An item was also included at the end of the questionnaire inviting midwives to participate in a focus group to discuss their experiences around immersion in water for labour or birth. Prior to commencing the focus group midwives were reminded that their privacy would be maintained by issuing each of them a unique identifier; the discussions linked to an individual’s identity should ‘remain in the room’; and that the focus group would be audio recorded. All midwives verbally consented to these conditions.

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The authors declare that they have no competing interests.

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Midwives satisfaction with waterbirth questionnaire. (PDF 184 kb)

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Focus group questions. (DOCX 12 kb)

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Lewis, L., Hauck, Y.L., Butt, J. et al. Midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth. BMC Pregnancy Childbirth 18 , 249 (2018). https://doi.org/10.1186/s12884-018-1823-0

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J Epidemiol Glob Health
v.10(2); 2020 Jun

The Crucial Role of Midwives in Preventing Maternal Sepsis: It All Started in a Maternity Ward

Alexandra peters.

1 Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

Sotoudeh Ghasemi

2 Department of Medicine, University of Geneva, Geneva, Switzerland

Didier Pittet

Every year, over 100 million patients around the world suffer from Healthcare-associated Infections (HAIs). Of these infections, one of the worst is sepsis, which causes a total of 16 million deaths around the world every year [ 1 ]. Hand hygiene is key in infection prevention and microbial transmission, including sepsis. Most HAIs are due to healthcare workers’ hands. Sepsis is often underreported because it is caused by a number of different pathogens (bacterial, viral, and fungal) [ 2 ].

Sepsis is a life-threatening dysfunction of vital organs that is caused by a dysregulated response to infection [ 3 ]. It causes serious complications, especially in low- and middle-income settings, and is a major cause of morbidity and mortality for mothers and babies [ 4 ].

In its early stages, sepsis is difficult to diagnose and often, patients are in critical conditions by the time they are diagnosed.

Each year 3 million newborns are affected by sepsis and 500,000 of them die as a result [ 5 ]. Maternal sepsis is one of the leading causes of mortality, and represents 11% of maternal deaths [ 6 ]. This high maternal and neonatal mortality rate due to sepsis could be reduced with improved practices that include hand hygiene, a clean healthcare environment, sterile medical tools, and implementation of infection prevention core components by caregivers [ 1 ]. During deliveries, the main tool that midwives use is their hands, as they constantly run vaginal inspections and check the cervix dilatation, which makes the role of hand hygiene especially important.

Nurses, midwives, and other healthcare professionals are in direct contact with patients while providing them care, but they can also transfer bacteria and viruses to patients while working. This is one of the most common reasons that HAIs are transmitted, but they can be prevented by a simple gesture: hand hygiene [ 7 ]. Studies proved that using alcohol-based handrub during appropriate times of providing care, as defined by the World Health Organization (WHO) 5 Moments for Hand Hygiene, is effective in avoiding infection transmission [ 8 ]. It is also a very good investment as preventing infections costs far less to healthcare systems and countries than treating them does [ 9 ]. This is the reason why the WHO has dedicated the 5th of May as the international hand hygiene day since 2009 with the “Save Lives: Clean Your Hands” campaign [ 10 ].

The WHO has declared 2020 as the Year of the Nurse and the Midwife [ 11 ]. The 5th of May is a perfect time to celebrate the role of nurses and midwives in infection prevention, and the importance of hand hygiene in their work. Moreover, the International Confederation of Midwives has designated the 5th of May as the Midwifery Day since 1991 so the momentum of both designated days will be celebrated around the world [ 12 ].

Midwives have a fundamental role in the well-being of mothers and newborns. They accompany women from the first day of their pregnancy through, and even after their delivery. They are trained in both medical and psychological fields, and help mothers with activities such as breastfeeding and are there to support both them and their partners. Midwives often act as the link between newborns, their parents, and primary care physicians, thus helping to ensure the health and development of the infant. Although the exact nature of their work may vary somewhat around the world but they remain indispensable for the heath of women and babies in health systems around the world [ 5 ].

1. WHERE HAND HYGIENE IN HEALTHCARE STARTED

On this 5th of May, it is also a good opportunity to remember that the origins of hand hygiene as we know it today were in the maternity ward. The father of hand hygiene, Ignác Philipp Semmelweis practiced as a professor’s assistant in the obstetrics department of the Vienna General Hospital. As he began his career in 1846, he faced the shocking reality of the maternity ward: childbed fever was a common issue for the 19th century women [ 13 ]. Many of new mothers died of puerperal fever after giving birth but it never was considered a preventable disease. Semmelweis wanted to understand what was happening, and started his surveillance. The Vienna General Hospital had two connected wards, one mostly run by midwives and another with medical students and doctors. His observations showed that between these two wards, the mortality rate was much higher with doctors than midwives. The interesting part was that pregnant women ready to deliver were randomly assigned to a different ward based on the day of the week. While trying to figure out why this was so, a colleague, Jakob Kolletschka, died of a similar disease after injuring himself accidentally with a scalpel during an autopsy. Doctors and medical students were frequently doing autopsies and postmortem examinations before being called to delivery rooms, which was not the case for midwives [ 14 ].

Semmelweis soon presented his hypothesis about “cadaverous particles” remaining on hands and being transferred to women. He believed that clean practices could help to avoid childbed fever, and tried different solutions to wash his hands. He chose a chlorinated lime solution as he found it to be better at removing bad odors after autopsies. He implemented hand hygiene practices among the physicians to test his hypotheses, and lowered the rate of childbed fever to the level of the ward where the midwives worked [ 15 ]. Nothing was “inevitable” about the childbed fever—the doctors’ hands were the culprits!

2. TODAY’S CALL

The importance of hand hygiene was not accepted at Semmelweis’ time, even if it proved itself effective. This shows changing human behavior is difficult, and this is why the WHO began this yearly hand hygiene campaign and developed their multimodal strategy. Although rates of childbed fever have been markedly reduced today, many women are still dying of sepsis after labor. We should take the opportunity of this 5th of May to celebrate hardworking nurses and midwives as well as highlight the crucial role that they play in infection prevention for mothers and babies. It isn’t just clean practice, it’s lifesaving. The WHO makes this clear in the message for midwives for World Hand Hygiene Day: “Your hands make all the difference for mothers and babies [ 11 ].”

ACKNOWLEDGMENTS

This work is supported by the Infection Control Programme (SPCI), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; hand hygiene research activities at the SPCI are also supported by the Swiss National Science Foundation (grant no. 32003B_163262 ).

CONFLICTS OF INTEREST

Didier Pittet works with WHO in the context of the WHO initiative “Private Organizations for Patient Safety – Hand Hygiene”. The aim of this WHO initiative is to harness industry strengths to align and improve implementation of WHO recommendations for hand hygiene in healthcare indifferent parts of the world, including least developed countries. In this instance, companies/industries with a focus on hand hygiene and infection control-related advancement have the specific aim of improving access to affordable hand hygiene products as well as through education and research. All listed authors declare no financial support, grants, financial interests or consultancy that could lead to conflicts of interest.

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. WHO takes no responsibility for the information provided or the views expressed in this paper.

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What is the intervention/issue you want to know more about? This could be a particular type of medication, education, therapeutic technique etc.
Do you have a particular context in mind? This could relate to a community setting, hospital, ward etc.

It is important to remember that databases will only ever search for the exact term you put in, so don't panic if you are not getting the results you hoped for. Think about alternative words that could be used for each keyword to build upon your search.

Build your search by thinking about about synonyms, specialist language, spellings, acronyms, abbreviations for each keyword that you have.

Inclusion & Exclusion Criteria

Your inclusion and exclusion criteria is also an important step in the literature review process. It allows you to be transparent in how you have ended up with your final articles.

Your inclusion/exclusion criteria is completely dependent on your chosen topic. Use your inclusion and exclusion criteria to select your articles, it is important not to cherry pick but to have a reason as to why you have selected that particular article.

Search Planning Template Use this template to plan your search strategy.

Once you have thought about your keywords and alternative keywords, it is time to think about how to combine them to form your search strategy. Boolean operators instruct the database how your terms should interact with one another.

Boolean Operators

OR can be used to combine your keywords and alternative terms. For example "Social Media OR Twitter". When using OR we are informing the database to bring articles continuing either of those terms as they are both relevant so we don't mind which appears in our article.
AND can be used to combine two or more concepts. For example "Social Media AND Anxiety". When using AND we are informing the database that we need both of the terms in our article in order for it to be relevant.
Truncation can be used when there are multiple possible word endings. For example Nurs* will find Nurse, Nurses and Nursing.
Double quotation marks can be used to allow for phrase searching. This means that if you have two or more words that belong together as a phrase the database will search for that exact phrase rather than words separately. For example "Social Media"

Don't forget the more ORs you use the broader your search becomes, the more ANDs you use the narrower your search becomes.

One of the databases you will be using is EBSCOHost Research Databases. This is a platform which searches through multiple databases so allows for a comprehensive search. The short video below covers how to access and use EBSCO.

A reference management software will save you a lot of time especially when you are looking at lots of different articles.

We provide support for EndNote and Mendeley. The video below covers how to install and use Mendeley.

Consider using a research question framework. A framework will ensure that your question is specific and answerable.

There are different frameworks available depending on what type of research you are interested in.

Population - Who is the question focussed on? This could relate to staff, patients, an age group, an ethnicity etc.

Intervention - What is the question focussed on? This could be a certain type of medication, therapeutic technique etc.

Comparison/Context - This may be with our without the intervention or it may be concerned with the context for example where is the setting of your question? The hospital, ward, community etc?

Outcome - What do you hope to accomplish or improve etc.

Sample - as this is qualitative research sample is preferred over patient so that it is not generalised.

Phenomenon of Interest - reasons for behaviour, attitudes, beliefs and decisions.

Design - the form of research used.

Evaluation - the outcomes.

Research type -qualitative, quantitative or mixed methods.

All frameworks help you to be specific, but don't worry if your question doesn't fit exactly into a framework.

There are many critical appraisal tools or books you can use to assess the credibility of a research paper but these are a few we would recommend in the library. Your tutor may be able to advise you of others or some that are more suitable for your topic.

Critical Appraisal Skills Programme (CASP)

CASP is a well-known critical appraisal website that has checklists for a wide variety of study types. You will see it frequently used by practitioners.

Understanding Health Research

This is a brand-new, interactive resource that guides you through appraising a research paper, highlighting key areas you should consider when appraising evidence.

Greenhalgh, T. (2014) How to read a paper: The basics of evidence-based medicine . 5 th edn. Chichester: Wiley

Greenhalgh’s book is a classic in critical appraisal. Whilst you don’t need to read this book cover-to-cover, it can be useful to refer to its specific chapters on how to assess different types of research papers. We have copies available in the library!

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Taking into Account the Upper Temperature Limit of the Metastable States of Condensed Systems in Chemical Thermodynamic Calculations

Published: November 2000
Volume 34 , pages 570–576, ( 2000 )

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O. F. Shlenskii 1 &
N. M. Ievleva 2

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It is proposed to modify the conventional equations of chemical thermodynamics to account for deviations from the equilibrium state and for the existence of the upper temperature limit of the metastable states of volatile and nonvolatile chemically unstable substances.

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Thermodynamic Analysis of Peculiarities of the State Diagrams of Chemically Reacting Systems in the Vicinity of Critical Points

A. M. Toikka, B. I. Gorovits & M. A. Toikka

Modeling Phase Transition and Metastable Phases

Second Law of Thermodynamics, Gibbs’ Thermodynamics, and Relaxation Times of Thermodynamic Parameters

Yu. K. Tovbin

Shlenskii, O.F. and Zyrichev, N.A., Experimental Determination of the Microkinetic Parameters of Thermal Decomposition of Materials, Khim. Vys. Energ. , 1994, vol. 28, no.1, p. 280.

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Shlenskii, O.F., Afanas'ev, N.V., and Shashkov, A.G., Termorazrushenie materialov (Thermal Destruction of Materials), Moscow: Energoatomizdat, 1996.

Skripov, V.P., Sinitsyn, E.N., Pavlov, P.A., et al. , Teplofizicheskie svoistva zhidkostei v metastabil 'nom sostoyanii (Thermophysical Properties of Liquids in the Metastable State), Moscow: Energoatomizdat, 1980.

Pavlov, P.A., Dinamika vskipayushchikh zhidkostei (Dynamics of Boiling-Up Liquids), Sverdlovsk: Ural. Otd. Akad. Nauk SSSR, 1988.

Lomonosov, I.V., Fortov, V.E., and Khishchenko, K.V., Model for Wide-Range Equations of State at High Energy Densities, Khim. Fiz. , 1995, vol. 14, no.1, p. 47.

Khishchenko, K.V., Lomonosov, I.V., Fortov, V.E., and Shlenskii, O.F., Thermodynamic Properties of Plastics over a Wide Density and Temperature Range, Dokl. Akad. Nauk , 1996, vol. 349, no.1, p. 322.

Polezhaev, Yu.V. and Yurevich, F.B., Teplovaya zashchita (Thermal Protection), Moscow: Energiya, 1976.

Shlenskii, O.F. and Ievleva, N.M., Mathematical Models of High-Energy-Induced Phase and Chemical Transformations in Condensed Matter, Khim. Vys. Energ. , 1999, vol. 33, no.4, p. 321.

Shlenskii, O.F. and Ievleva, N.M., Temperature Constraints in the Mathematical Models of the Chemical Physics of Condensed Matter, Khim. Fiz. , 1999, vol. 18, no.2, p. 66.

Rusanov, A.I., Fazovye ravnovesiya i poverkhnostnye yavleniya (Phase Equilibria and Surface Phenomena), St. Petersburg: Khimiya, 1996.

Storonkin, A.V., Termodinamika geterogennykh sistem (Thermodynamics of Heterogeneous Systems), Leningrad: Leningr. Gos. Univ., 1967.

Stromberg, A.G. and Semchenko, D.P., Fizicheskaya khimiya (Physical Chemistry), Moscow: Vysshaya Shkola, 1988.

Slensky, O.F. and Aksenov, L.N., A Modified Contact Heater for Polymer Destruction Studies, J. Therm. Anal. , 1996, vol. 47, p. 1171.

Zyrichev, N.A., Plasma Chemical Methods in the Complex Processing of Minerals and Industrial Waste: New Applications and Their Scientific and Engineering Foundations, Doctoral (Eng.) Dissertation, Moscow: State Inst. of the Nitrogen Industry, 1998.

Zyrichev, N.A. and Shlenskii, O.F., Decomposition Kinetics of Hydrated Nitrates under High-Frequency Plasma Heating Conditions, Khim. Vys. Energ. , 2000, vol. 34, no.1, p. 46.

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Shlenskii, O.F., Ievleva, N.M. Taking into Account the Upper Temperature Limit of the Metastable States of Condensed Systems in Chemical Thermodynamic Calculations. Theoretical Foundations of Chemical Engineering 34 , 570–576 (2000). https://doi.org/10.1023/A:1005225024560

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Hugo Dewar 1957

The Moscow Trials ‘Revised’

Source : Problems of Communism , Volume 6, no 1, January-February 1957. Scanned and prepared for the Marxist Internet Archive by Paul Flewers.

For many years Soviet propagandists and pro-Soviet Western observers presented ‘Soviet justice’ as a forward step in the advancement of legal science. Thus, the British jurist DN Pritt wrote, in a contemporary eulogy of the Moscow purge trials of the 1930s, that ‘the judicature and the prosecuting attorney of the USSR [Andrei Vyshinsky] have established their reputation among the legal systems of the world’. [1] Pritt was not at all disconcerted by the singular fact, unparalleled in Western jurisprudence, that the accused in the Soviet trials did not raise a finger to defend themselves, but instead confessed with seeming eagerness to the most heinous crimes. The Soviet government, he blandly stated, ‘would have preferred that all or most of the accused should have pleaded not guilty and contested the case’. [2]

The naïveté, or wilful blindness, of such statements has long been apparent. As early as 1937, an independent commission of inquiry conducted an exhaustive investigation into the Moscow trials of 1936 and 1937 and found them to be clear-cut travesties of justice. [3] The commission’s findings were bolstered by an ever-mounting accumulation of evidence regarding the methods employed to produce the victims’ obviously abnormal eagerness to sign their own death warrants.

Today not even the most naïve apologist can continue his self-deception. At the Twentieth Congress of the CPSU the myth was broken for all time when Nikita Khrushchev, in a secret report to a closed session of the congress, revealed the depths to which Soviet ‘justice’ had sunk:

Stalin originated the concept ‘enemy of the people’. This term automatically rendered unnecessary that the ideological errors of a man or men engaged in a controversy be proven... The formula was specifically introduced for the purpose of physically annihilating such individuals... [4]

It is significant, however, that, in denouncing ‘violations of socialist law’, Khrushchev made no direct mention either of the show trial as such, or of its exportation to the satellites. His remarks about Zinoviev and Kamenev and about the ‘annihilation’ of Lenin’s closest colleagues as ‘enemies of the party’ were furthermore clear attempts to restrict the discussion to ‘violations of socialist law’ in the period following Kirov’s assassination in December 1934 – to the great trials and purges of the 1930s. [5]

This effort is a transparent indication that the present collective leadership cannot make a decisive, radical break with their Stalinist past. It is to Stalin that the present Soviet leaders owe their positions, and it was during his reign that their methods of ‘governing’ and dispensing ‘justice’ were decisively moulded. That is why Khrushchev and his colleagues will not admit that the genesis of the Stalin-type inquisitorial trial goes much farther back than 1934, indeed, as far back as 1922.

The idea of exploiting the judicial trial of political opponents for the purpose of ‘educating’ the masses was first given concrete expression in 1922, when a trial of 22 prominent members of the Social Revolutionary Party was staged. At that time the technique of the show trial had not been perfected, and only ten police stooges consented to play the role of cringing penitents and government propagandists. At first, the state was content with this number and even permitted the rest to defend themselves stoutly. They openly proclaimed their political convictions and even refused to recognise the court. Just prior to the trial, the Bolsheviks entered into an agreement in Berlin with representatives of the international socialist movement by which several prominent socialists were invited to participate in the defence; and in the early stages of the trial they were very active on behalf of the accused. As the trial progressed, however, the intolerable contradictions between accepted conceptions of justice and a Soviet-sponsored political trial were revealed. Bit by bit the essential elements of the show trial, with which the world later became familiar, emerged.

The presiding judge struck the keynote for the proceedings by declaring that the court would be guided not by objective considerations but by the interests of the government. During the course of the trial Bukharin declared the Berlin agreement null and void, and this, coupled with the prosecution’s obstructive tactics, caused the foreign socialists to withdraw. Perhaps most important in the development of the show trial, however, was the first utilisation of the technique of agitating against the accused outside of court. Yuri Pyatakov, the president of the tribunal, spoke at one of the mass demonstrations, as did Bukharin, who applauded the role played in the trial by the ten who had ‘confessed’. [6]

In the course of the next few years the show trial was gradually brought to a high stage of perfection. ‘Evidence’ was manufactured and, by means of inhuman tortures, the accused were brought into court ‘prepared’ to cooperate in arranging their own destruction. During the course of the so-called Shakhty trial (1928), for example, a group of engineers, personifying the ‘bourgeois specialists’, took the blame for the country’s chronic economic ills and accused foreign ‘interventionist circles’ of directing their sabotage. [7] By 1930 the technique had been further perfected, and during the Industrial Party trial every single one of the accused confessed to ‘planned’ sabotage in drafting or implementing the First Five-Year Plan. One of the witnesses, brought in under heavy GPU guard, was Professor Osadchy, formerly a member of the CEC (Central Economic Council) of the Supreme Soviet, and assistant chairman of the State Planning Commission. Incredible as it may seem, Osadchy, who was one of the prosecutors at the Shakhty trial, confessed to having plotted with the very men whom he had sentenced to death in 1928! [8]

Stalin’s speech at the Sixteenth Congress (June-July 1930) gave at least the outward rationale for all the great Moscow trials. [9] His thesis was that whenever the contradictions inherent within the capitalist system grow acute, the bourgeoisie tries to solve them by turning on the Soviet Union. By the bourgeoisie Stalin meant primarily foreign nations, but his main purpose was to justify the purge of internal opposition to his rule. The vast international ‘plots’ which were uncovered regularly involved certain native Communists; often these were among the most celebrated of the revolutionary heroes, their ‘crimes’ consisting in their opposition to Stalin’s dictatorship. Without respect to their previous service, these men were condemned as saboteurs working in collaboration with the outside enemy to wreck the economy of the Soviet Union.

Thus, the Great Purge, as well as the thousands of unpublicised local purges, served the double purpose of removing those who opposed Stalin and of providing for the population an ‘explanation’ of the continuing low standard of living. Vyshinsky made the point in the following manner:

It is now clear why there are interruptions of supplies here and there, why with our riches and abundance of products, there is a shortage first of one thing and then of another. It is these traitors who are responsible. [10]

Vyshinsky also underlined the connection between the various trials. Stalin’s thesis had been proved, he said: all the trials had uncovered ‘systematically conducted espionage... the devilish work of foreign intelligence...’. [11]

Characteristically, although it was ostensibly against Stalin’s thesis and its implications that Khrushchev railed at the Twentieth Congress, his anger was aroused most of all by the fact that Stalin’s wrath had been turned against the party itself:

Using Stalin’s formulation... the provocateurs who had infiltrated the state security organs together with conscienceless careerists... [launched] mass terror against party cadres... It should suffice to say that the number of arrests based on charges of counter-revolutionary crimes had grown ten times between 1936 and 1937. [12]

Khrushchev summed up the Stalin era in anguished tones:

In the main, and in actuality, the only proof of guilt used, against all norms of current legal science, was the ‘confession’ of the accused himself; and, as subsequent probing proved, ‘confessions’ were acquired through physical pressures against the accused. [13]

Khrushchev’s speech is a masterpiece of hypocrisy. To be sure, of the 1966 delegates to the Seventeenth Party Congress (1934), 1108 were arrested on charges of counter-revolutionary activity. But Khrushchev well knows that it was not a question of ‘subsequent probing’: every leading Communist in the Soviet Union knew at the time what was going on. They were aware that the ‘confessions’ were shot through with contradictions and obvious absurdities; they knew that the trials were frame-ups.

As a matter of fact, Khrushchev’s speech itself corroborates our previous evidence that the Politburo was well aware of what was going on:

At the February-March Central Committee Plenum in 1937 many members actually questioned the rightness of the established course regarding mass repressions under the pretext of combating ‘two-facedness’. [14]

Khrushchev thus confirms that opposition to Stalin’s iron-heel policy was expressed even within the Politburo. People who had employed the most despicable methods against both non-party and party opponents began to voice ‘doubts’ when the police terror menaced them. Among those who ventured to speak up in 1937 was Pavel Postyshev, candidate member of the Politburo. Indeed, Khrushchev said that Postyshev expressed his doubts ‘most ably’, as did Stanislav Kossior, a member of the Politburo – both were liquidated. Other prominent Stalinist victims of the monster they themselves helped create were Vlas Chubar, Yan Rudzutak, Grigory Petrovsky and Robert Eikhe: all men of the Lenin era who had thrown in their lot with Stalin in his struggle for power.

How was it, then, that Molotov, Mikoyan, Voroshilov, Khrushchev and others survived? They saved themselves either by keeping their mouths shut or, where their closeness to Stalin made this impossible, by sedulously fostering the cult of the ‘brilliant leader’. Certainly Khrushchev was not unaware of what was going on. Kossior, for example, was purged in the Ukraine while he was closely associated with Khrushchev.

Without speculating about the possible splits and rivalries within the top leadership of the CPSU revealed by the varying degrees of vehemence with which individual Soviet leaders condemned Stalin’s ‘cult of personality’, the central goal of the leadership as a whole is perfectly obvious. Khrushchev and his supporters are vitally concerned with ‘rehabilitating’ the party and strengthening its authority vis-à-vis the police apparatus. The terrors of the Stalinist era left party cadres either demoralised and spiritless or, much worse, cynically and brutally opportunistic. In any event, the leadership felt that the support of the new generation of Communists – the managerial caste and the intellectuals – required assurances that the days of arbitrary terror were over. In Khrushchev’s words:

Arbitrary behaviour by one person encouraged and permitted arbitrariness in others. Mass arrests and deportations of many thousands of people, execution without trial and without normal investigation created conditions of insecurity, fear and even desperation. [15]

The exportation of the macabre and revolting confessional trial to Eastern Europe was never much of a success. The process that had transformed the CPSU into a terrorised and docile instrument of the leader took 14 years; in Poland, Bulgaria and Hungary it was telescoped into less than four years – somewhat longer in Czechoslovakia and Rumania. During this time the weak satellite Communist parties (only in Czechoslovakia could the Communists claim any sizeable following) were deprived of their ablest leaders. It was clear from the trials, moreover, that these leaders were imprisoned and executed because they attempted to stand up to the Soviet Union and that the leaders who remained were mere Soviet satraps. The confession trials of ‘national Communists’ therefore destroyed what little basis the Communist parties had for claiming to represent national interests, or even the interests of the industrial workers. At the same time, they failed dismally to destroy either national sentiment among the people or Titoist tendencies within the rank-and-file of the Communist parties.

Quite on the contrary, there can be no doubt that the confession trials in Eastern Europe played a great role in enhancing anti-Soviet feeling and in undermining the Communist parties’ faith in themselves. The enormous crowds that attended the reinternment of Rajk in Hungary after his posthumous rehabilitation were symptomatic of the anti-Soviet mood that had been generated by the ‘educational’ methods of Soviet-inspired ‘justice’. The bloodless revolt in Poland and the heroic uprising of the Hungarian workers, peasants and intellectuals were due in large part to the exposure of Soviet methods and aims which resulted from the export of the ‘modern inquisition’. The people of the satellite nations share with the Russian people a deep and bitter hatred of the secret police, and a deathless desire to end the insufferable horrors which the confession trial represented.

That the Soviet leaders were, and remain, keenly aware of this was implicit in their repudiation at the Twentieth Congress of the Stalinist inquisition and in the gradual steps that have been instituted to correct some of the more objectionable features of the police and judicial apparatus. They obviously are attempting to restore public confidence in a party and system that had become thoroughly and openly compromised. In so doing, however, they paradoxically underlined still further the bankruptcy of the system that claimed to have produced that ‘glorious workers’ paradise’, the ‘most advanced country in the world’, and they reveal nakedly their inability to cast off the imprint of this system of terror and ‘educational justice’.

1. DN Pritt, The Moscow Trial Was Fair (Russia Today, London, nd).

2. DN Pritt, The Zinoviev Trial (Gollancz, London, 1936).

3. This Commission was headed by the noted American philosopher, John Dewey. Its findings were published in two books: The Case of Leon Trotsky (Secker and Warburg, London, 1937); and Not Guilty (Secker and Warburg, London, 1938).

4. The Anti-Stalin Campaign and International Communism: A Selection Of Documents (Columbia University Press, New York, 1956), p. 13.

5. For a full discussion of these trials see this author’s The Modern Inquisition (Allan Wingate, London, 1953).

6. The most complete record of this trial is in VS Voitinski, The Twelve Who Are About To Die (Delegation of the Party of Socialists-Revolutionists, Berlin, 1922). The death sentences passed against the accused were never carried out.

7. No official records of this trial have been published. Of secondary sources, the best are HH Tiltman, The Terror in Europe (Frederick A Stokes, New York, 1932); and Eugene Lyons, Assignment in Utopia (Harcourt, Brace, New York, 1937), especially pp. 114-33.

8. Andrew Rothstein (ed), Wreckers on Trial (Modern Books, London, 1931).

9. Some of the sources on the most important Moscow trials are the following: on the 1931 Menshevik trial – The Menshevik Trial (Modern Books, London, 1931); on the 1933 Metropolitan-Vickers Industrial Company Trial – The Case of NP Vitvitsky... [and others] Charged With Wrecking Activities at Power Stations in the Soviet Union (three volumes, State Law Publishing House, Moscow, 1933); on the 1936 trial – The Case of the Trotskyite – Zinovievite Terrorist Centre (People’s Commissariat of Justice of the USSR, Moscow, 1936); on the 1937 trial – Report of Court Proceedings in the Case of the Anti-Soviet Trotskyite Centre (People’s Commissariat of Justice of the USSR, Moscow, 1937); on the 1938 trial – Report of Court Proceedings in the Case of the Anti-Soviet ‘Bloc of Rights and Trotskyites ’ (People’s Commissariat of Justice of the USSR, Moscow, 1938).

10. Report of Court Proceedings in the Case of the Anti-Soviet ‘Bloc of Rights and Trotskyites ’, pp. 636-37.

11. Report of Court Proceedings in the Case of the Anti-Soviet ‘Bloc of Rights and Trotskyites ’, pp. 636-37.

12. The Anti-Stalin Campaign , p. 30.

13. The Anti-Stalin Campaign , p. 12.

14. The Anti-Stalin Campaign , p. 29.

15. The Anti-Stalin Campaign , p. 14.

Hugo Dewar Archive

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Certified Nurse Midwife (CNM) Certified Nurse Midwives are dually trained in midwifery and nursing and have met the standards for certification set by the American Midwifery Certification Board. Most midwives are CNMs. The vast majority of CNMs work in hospitals, and they attend more than 7% of births in the US.
Midwifery Dissertations
Midwifery is a health profession concerned with the care of mothers and all stages of pregnancy, childbirth, and early postnatal period. Those that practice midwifery are called midwives. ... Latest Midwifery Dissertations. Including full dissertations, proposals, individual dissertation chapters, and study guides for students working on their ...
The Impact of Midwifery on Infant and Maternal Outcomes Among Black Mothers
Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2021 The Impact of Midwifery on Infant and Maternal Outcomes ... that midwifery could be a mediating mechanism between elements of systemic and . 3 structural racism and individual risk factors in mothers (Allen et al., 2019; Alliman &
80 Midwifery Dissertation Topics
A List Of Potential Dissertation Topics In Midwifery: Investigating the impact of COVID-19 on midwifery education and training. The effect of midwifery-led care on reducing interventions in birth. Understanding the role of midwives in addressing birth disparities among minority women.
Midwife experiences of providing continuity of carer: A qualitative
A Comparative Study of Caseload Managed Midwifery Care and Team Midwifery [dissertation]. University of Glamorgan, 1999. Google Scholar] Open table in a new tab 4.4.3.1 'More than a job' Words used to describe this connection that the midwives felt with their role were, 'special', and 'vocation' symbolising their feeling that this ...
Nursing and Midwifery (Theses and Dissertations)
Lynch, Louise Annmarie (Trinity College Dublin. School of Nursing & Midwifery. Discipline of Nursing, 2024) Methods This thesis explores the sedentary behaviour (SB) levels of adults with an intellectual disability using diverse self-report methods and an objective measurement tool, to ultimately determine the effects of this ...
University of Bolton Library: Midwifery: Theses and Dissertations
To access the repository, please enrol on the Undergraduate Dissertations Moodle site . All examples on the repository received a mark of 2:1 or above. Examples are available from a number of subject areas, including Business and Management, Dental Technology and Health and Social Care. We welcome further submissions from academic staff.
Midwifery and Antenatal Care for Black Women: A Narrative Review
Interest in midwifery-attended birth is resurging, as recently noted by the American College of Nurse-Midwives (ACNM). A ACNM (2014) report titled "CNM/CM-Attended Birth Statistics in the United States" stated that 12.1% of all vaginal births in the United States were attended by certified nurse-midwives (CNMs) and certified midwives (CMs). ACNM's numbers do not reflect the practice of ...
Doctoral Thesis Collection
This midwifery PhD thesis collection is an exciting new initiative for the RCM. The aim of the collection is to provide a platform for midwives to showcase their academic work, and to inspire and support midwives who are considering or who are currently undertaking further academic study. Additionally, the collection will provide a source of ...
Midwives' experience of their education, knowledge and practice around
Phase one. Table 1 summarises the midwives' perception of their education, knowledge and practice around immersion in water for labour and birth. A total of 29 (85%) out of a potential 34 midwives returned a questionnaire. The mean time midwives were qualified was 162 months (13 years and 5 months), with the mean time midwives had been facilitating waterbirth being 83 months (eight years and ...
The Crucial Role of Midwives in Preventing Maternal Sepsis: It All
The 5th of May is a perfect time to celebrate the role of nurses and midwives in infection prevention, and the importance of hand hygiene in their work. Moreover, the International Confederation of Midwives has designated the 5th of May as the Midwifery Day since 1991 so the momentum of both designated days will be celebrated around the world .
British Journal Of Midwifery
Induction of labour is one of the most frequently performed interventions in pregnancy, accounting for around 25% of all births in England (NHS Digital, 2017) Induction carries the risk of further interventions and is associated with increased pain in labour and an increased likelihood of instrumental delivery (Shetty et al, 2005; National Institute for Health and Clinical Excellence (NICE ...
European Journal of Midwifery
Slovenian midwifery professionalization: Perception of midwives and related health professions Most cited. 3 years Year . Midwives' experiences of traumatic births: A systematic review and meta-synthesis. Cesarean section rates in the COVID-19 era: False alarms and the safety of the mother and child ...
LibGuides: Nursing and Midwifery: Literature Reviews
The first step is to decide on a topic. Here are some elements to consider when deciding upon a topic: Choose a topic which you are interested in, you will be looking at a lot of research surrounding that area so you want to ensure it is something that interests you. Draw on your own experiences, think about your placement or your workplace.
British Journal Of Midwifery
Barriers and facilitators to infection prevention and control guidelines adherence: an integrative review. An integrative review was chosen for this study as it captures the dynamics and development of new knowledge of a phenomenon under study (Torraco, 2016). This is achieved through a review and critique... Showing 1 to 12 of 58 results.
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Welcome to the Midwifery Subject Guide. This is your guide to how the library can support you when studying and researching Midwifery at UWS. You will find links to the publicly available and specialist information resources (books, journals, subject-specific bibliographic databases) you'll be expected to use to find the best research evidence.
Oscillatory processes in the interaction of air-dry soils with water
Doklady Biological Sciences - Tyulin, A.F., Organo-mineral'nye kolloidy v pochve, ikh genezis i znachenie dlya kornevogo pitaniya vysshikh rastenii (Organomineral Colloids in Soil: Origin and Role in Root Nutrition of Higher Plants), Moscow: AN SSSR, 1958. Google Scholar . Fedotov, G.N., Gel Structures in Soils, Doctoral (Biol.) Dissertation, Moscow, 2006.
Communities of microorganisms and invertebrates in soil-like ...
Artificially created soil-like technogenic formations (STFs) of soccer fields are developed under combined action of intense technogenic and natural factors and processes, which cannot but affect the structure and biological activity of their microbial communities and mesofauna. The microflora of the STFs is very similar to the microflora of the background soddy-podzolic soils of Moscow oblast ...
Taking into Account the Upper Temperature Limit of the ...
Zyrichev, N.A., Plasma Chemical Methods in the Complex Processing of Minerals and Industrial Waste: New Applications and Their Scientific and Engineering Foundations, Doctoral (Eng.) Dissertation, Moscow: State Inst. of the Nitrogen Industry, 1998. Google Scholar
PDF Spring 2024 (4/1/24 thru 6/14/24) School of Nursing
32051 NMID 795 Practicum in Nurse-Midwifery Management III 2 Jennifer Jagger Kaeser W 1300-1450 SN 107 FTF & Sakai, Class will meet EVEN Weeks. OSCE 5/17/24 RLSB ... 32066 NURS 603 Doctoral Dissertation 1 - 8 Kristin Cloyes Students to arrange with faculty, then register through SIS
The Moscow Trials 'Revised' by Hugo Dewar 1957
The Moscow Trials 'Revised'. Source: Problems of Communism, Volume 6, no 1, January-February 1957. Scanned and prepared for the Marxist Internet Archive by Paul Flewers. For many years Soviet propagandists and pro-Soviet Western observers presented 'Soviet justice' as a forward step in the advancement of legal science.

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Topic:2 Alcohol Abuse

Topic:3 Birth Planning

Topic:4 Community midwifery

Topic:5 Contraception

Topic:6 Electronic fetal monitoring

Topic:7 Family planning

Topic:8 Foetal and newborn care

Topic:9 Foetal well being

Topic:10 Gender-based violence

Topic:11 Health promotion

Topic:12 High-risk pregnancy

Topic:13 HIV infection

Topic:14 Human Rights

Topic:15 Infection prevention and control

Topic:16 Infertility and pregnancy

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Midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth

Conclusions

Participants and setting

Recruitment and data collection

Data analysis

Phase two: Qualitative data

Caring for women who labour or birth in water

Instinctive birthing

Woman-centred atmosphere

Undisturbed space

The challenges midwives experienced with waterbirth

Learning through reflection

Facilities required to support waterbirth

Strengths and limitations

Abbreviations

Acknowledgements

Availability of data and materials

Author information

Contributions

Corresponding author

Ethics declarations

Competing interests

Publisher’s Note

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