Monday, November 15, 2010

Worth the weight?

Increasing numbers of British women are dieting during pregnancy, putting their children at risk of serious illness in later life, according to this article by Anita Chaudhuri. According to a study by Barker et al. for the Medical Research Council (MRC), pregnant women in Britain are dieting like never before, and the health implications are alarming. The findings indicated that four out of ten women eat a diet that is likely to deprive a child of essential nutrients.

Worried doctors opt for caesareans

The Observer of 23/10/04 features an unpublished Cambridge University survey which suggests that that fear of legal action is a major factor behind the rising number of caesarean sections performed during childbirth. The high rates of caesarean sections in the UK , which are up to 28 per cent of all births in some trusts, may have less to do with women choosing an operation, and more to do with doctors' anxieties about being sued. Two-thirds of obstetricians admitted that such anxieties influenced their decision.

However, the perception that patients are becoming more litigious is a myth not born out by the statistics, according to experts. The number of legal claims against NHS trusts actually fell by 20 per cent last year.

Baby sex link to domestic status (BBC News 20/10/04)

The living arrangements of parents at the time a baby is conceived may play a role in determining its sex, research suggests. A US study found parents who were married or living together before conception were slightly more likely to have a boy than those who were not. The study, by the US National Bureau of Economic Research, is based on data from 86,436 births. Details are published in Proceedings of The Royal Society.

Overall, the study found that 51.5% of babies born to couples living together at the time of conception were boys, compared to 49.9% among parents who were not.

Pregnant to be questioned on home violence (Independent 20/10/04)

Pregnant women are to be routinely asked by doctors and midwives if they have been beaten up by their partners in a new drive to tackle domestic violence. The move follows evidence that women are more vulnerable to domestic violence during pregnancy. Melanie Johnson, the Public Health minister, will announce plans today for questions to be put to women during their first NHS ante-natal visits.

The initiative means that health service professionals will play a vital role in rooting out hidden domestic violence. At NHS appointments during the early stages of pregnancy, such as for foetal scans, they will inquire whether women are being abused. Sufferers will be referred to appropriate support and counselling services or the police if it emerges that they need protection or want charges to be pressed.

New Chief Nursing Officer appointed (DH 19/10/04)

Health secretary John Reid has announced the appointment of Christine Beasley as England's new chief nursing officer.

For those of you who are not familiar with Christine Beasley she has held a wide range of nursing roles in hospitals and the community. Her most recent roles were as the NHS modernisation agency's Director of Partnership Development and then interim head of the agency.
On accepting the appointment Christine Beasley said that she was delighted to take up the post and was "looking forward to the challenge of ensuring all staff put hospital cleanliness and infection control at the top of the agenda".

The RCM welcomed this announcement, and said we are looking forward to working with the new chief nursing officer on a number of issues, including the extension of midwifery led care and further action to address the recruitment and retention of midwifes.

Risks of second caesarean studied (BBC News 19/10/04)

A study is being carried out to help women who have given birth by caesarean decide how to give birth the next time. The DiAMOND study - Decision Aids for Mode of Next Delivery - will question 600 pregnant mothers in Bristol, Somerset and Dundee. Researchers have developed two different methods of giving women information on the risks and benefits of natural and repeat caesarean. They will be compared to women who are given standard information. The joint Bristol and Dundee University study will measure if the new methods either prompt women to take a second caesarean or opt for natural birth.

Aerosols 'harm mother and baby'

A paper by Farrow et al., Farrow A, Taylor H, Northstone K, Golding J, Symptoms in mothers and infants and use of aerosols and air fresheners, has just been published in the journal Archives of Environmental Health. It is part of the ALSPAC 'Children of the 90s' study in Bristol. The work is featured on the BBC News and IC Wales web sites. Air fresheners and aerosols used in the home can cause diarrhea and earache in youngsters and depression in their mothers, according to the researchers.

Improving perinatal mental health care

Nursing Standard carries a freely-available article by Thomas Currid, lecturer at London South Bank University. (2004 19:3 40-43)

Pregnancy and the puerperium can bring many emotional, physical and social changes to the mother, her partner and the rest of the family. While many mothers find these changes – such as the experience of pregnancy or the addition of a new member to the family – joyous, some do not share these positive feelings and often undergo emotional upheaval resulting in severe biopsychosocial distress. This period of distress does not only subject the mother and her family to increased risk of psychological crisis, mental illness and developmental disturbances, but may also, if untreated, result in the fatalistic outcomes of infanticide or suicide. In this article, the author calls for a more robust, co-ordinated and interdisciplinary approach to perinatal mental health services.

Statistical bulletin: NHS contraceptive services 2003-4

In 2003-04:

- there were about 2.7 million attendances at family planning clinics, about 2% more than in 2002-03
- the number of women attending clinics was 1.20 million, about the same as in 2002-03
- the number of men attending clinics was 106 thousand, about 14% more than in 2002-03,
- the peak age for clinic attendance was 16-17; an estimated 23% of women in this age group visited a clinic during the year
- oral contraception was the primary method of 41% of clinic attenders; the male condom was the primary method of 35% of attenders
- emergency contraception was prescribed by clinics on 193,000 occasions, a decrease of 2% compared with 2002-03

A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects (BMC Pregnancy and Childbirth 2004 4 20)

Periconceptional use of vitamin supplements containing folic acid reduces the risk of a neural tube defect (NTD). In November 1998, food fortification with folic acid was mandated in Canada, as a public health strategy to increase the folic acid intake of all women of childbearing age. The researchers (Liu et al.) undertook a comprehensive population based study in Newfoundland to assess the benefits and possible adverse effects of this intervention.

The rates of NTDs fell by 78% (95% CI 65%-86%) after the implementation of folic acid fortification, from an average of 4.36 per 1,000 births during 1991-1997 to 0.96 per 1,000 births during 1998-2001. Based on these findings, mandatory food fortification in Canada should continue at the current levels. Public education regarding folic acid supplement use by women of childbearing age should also continue.

Marijuana use may increase the risk of ectopic (tubal) pregnancies, researchers at Vanderbilt University Medical Center (Dey et al.) reported this week. (Internet Medical Journal Monday 27th September)

The researchers studied CB1, a "cannabinoid" receptor that binds the main active chemical for marijuana, delta-9-tetrahydrocannabinol (THC).

In pregnant mice that lacked the gene for the receptor, or in which the receptor was blocked, the embryo failed to go through the oviduct – the tube leading from the ovaries to the uterus. The same thing happened in normal mice when the receptor was over-stimulated.

The study, published in the current issue of the journal Nature Medicine, describes for the first time how the CB1 receptor in the mouse regulates muscle contraction to move the embryo down the oviduct.

It is not known whether drugs that block or, in the case of marijuana, over-stimulate the CB1 receptor can cause ectopic pregnancy in humans. However, "our results raise caution for women of reproductive ages regarding the chronic use of marijuana for recreation or pain alleviation," the researchers concluded.

UK boost for Iraq maternity care (BBC News 30/08/04)

A team of UK doctors has helped reduce infant and maternal mortality in Iraq following a pioneering project to improve midwifery practices in the war-ravaged country. They have taught consultants and midwives how to deal with medical emergencies that can arise during childbirth without the need for expensive equipment, which they do not have.

The report states:

"Unwittingly, the British team made another impact in Iraq - by changing doctors and consultants' attitudes towards midwives. Mr Mathieson, who is also a senior lecturer in environmental health at Bristol's University of the West of England, which allowed him time off for the programme, said: "Nurses and midwives in Iraq are seen as second class citizens.

A party of Basra doctors currently on a visit to London have said what a huge difference we have made to their work. According to Andrew Mathieson, MOET trip co-ordinator, "They are mainly women and this is a misogynistic society." There were two or three midwives on each of the two courses of 18. The remainder were doctors, two-thirds of whom were women.
"We were teaching midwives the same sort of life-saving techniques as the doctors. Midwives are very experienced and this gave them the capability to support their experience. The doctors had a greater appreciation of what midwives are capable of after they had been on the course.
So we were making in-roads into changing attitudes towards midwives."

Matrons make their mark

The new Matron’s Charter will set out a clear direction for senior nurses to improve hospital hygiene and infection control.

A partnership of senior nurses and facilities staff, including representatives from the Royal College of Nursing, the Royal College of Midwives, the Infection Control Nurses Association, Healthcare Facilities Management Association and the Association of Domestic Managers, will develop the charter. Designed to help promote cleanliness across the NHS, it will include recommendations on creating stronger cleaning teams, clarify the responsibilities of staff and give patients a stronger voice.

The charter – due out in October – is a key part of a new national drive to improve NHS hygiene, infection control and cleanliness standards, as outlined in Towards Cleaner Hospitals and Lower Rates of Infection. Matrons have an important role to play in leading the cultural changes that will bring improved personal hygiene, better clinical practice and a cleaner environment.

"Power of touch" report

A report by Johnson's Baby (which unfortunately I cannot locate) claims that babies are being deprived of their mother's touch because of the excessive use of pushchairs and detachable car seats rather than slings which physically bring them close to their parent, a report claims today. Mild forms of sensory deprivation can come from the constant use of car seats - often used when babies are not even being driven - and pushchairs and prams, it suggests. Baby massage, however, is an increasingly

Midwife urges staffing review (Nursing Standard 08/09/04)

Cathy Warwick, of King's College Hospital NHS Trust, an NMC member, has suggested that maternity units should pool their staffing resources in regional co-operatives so that all women requesting a home birth can have one, an influential midwifery expert said last week. The idea is put forward in response to the Beland case, in which a midwife was dismissed for providing a women with a home birth in defiance of his trust's policies. The NMC is expected to issue revised guidelines soon on the home birth issue.

Does cannabis increase the risk of ectopic pregnancy? (BBC News 20/09/04)

Researchers at Vanderbilt University have published research that may implicate cannabis in the aetiology of ectopic pregnancy.

Sue Jacob's comments are featured:

Sue Jacob from the Royal College of Midwives said: "We need to look at the bigger picture.
"The rise in sexually transmitted infections, the rise in alcohol binging and the rise in drug taking all have an impact on sexual health. Ectopic pregnancies need to be researched further in light of these behaviours," she said.

Premature babies' disability risk (BBC News, 20/09/04)

Forty per cent of very premature babies have significant learning disabilities, according to the unpublished Epicure study. The study is following the developmental progress of 1,200 babies born alive at less than 26 weeks gestation in Britain and Ireland in 1995, just over 300 of whom survived to go home. The latest results show that 40% of the surviving children had moderate to severe problems in cognitive development at the age of six, compared to 2% of a control group of their classmates.

"Candles" ethnic minority recruitment project

A project in Slough to recruit more nursing and midwifery students from Asian and Caribbean backgrounds is featured in the Guardian of 18/09/04. It aims to counter negative attitudes to nursing among Indian and Pakistani communities. It is being run by Professor Elizabeth Anionwu of Thames Valley University. The project's target is to recruit 40 people from South Asian and Caribbean backgrounds on to student nurse and midwifery courses at Thames Valley University by September 2005.

Babies at risk from stress in pregnancy

An intriguing link between levels of anxiety in pregnant women and the damaging effect on the brain of the unborn child will be shown this week in a new study of ambidextrous children.

Researchers have discovered that women who are very anxious in the middle of their pregnancies are significantly more likely to have a child who is ambidextrous or 'mixed handed', a condition associated with autism, dyslexia and hyperactivity. It is the first time scientists have found such a link, and they believe it may be necessary for midwives to tackle mothers' stress levels to reduce the effects on the fetus.

The findings are based on information collected by a project based at the University of Bristol which looked at the lives of more than 7,400 mothers and children. The research, by Glover et al., was published in Early Human Development 79 (2) 2004 as "Antenatal maternal anxiety is linked with atypical handedness in the child".

National Service Framework for Children

On 15/09/04 the Department of Health published the National Service
Framework (NSF) for Children, Young People and Maternity Services. The
Children’s NSF is a 10-year programme intended to stimulate long-term and
sustained improvement in children’s health. Setting national standards for
health and social services for children, young people and pregnant women,
the NSF aims to ensure fair, high quality and integrated health and social
care from pregnancy, right through to adulthood.

The Children's NSF receives coverage in the Guardian, Times, and BBC News.

RCM Midwives Journal online content

The online content of the RCM Midwives Journal has now migrated to the Ingenta service ( and is no longer available at Issues from 5(10) 2002 can be browsed there. Access to full text is free of charge, though there is a six-month embargo on recent content, i.e. the most recent months are not available. Eventually all issues going back to 1998 will be put online.

Student Midwives' Sanctuary

This web site is a back online after an absence. I am a bit concerned about having specimen essays on the site - too much of a temptation to plagiarism, in my view. Students seem to worry a great deal about their dissertations, so a few specimens of this genre would be useful!

Erna Wright 1924-2004

The Guardian of 08/09/04 carries an obituary of Erna Wright, who in the early 1960s introduced the Lamaze method of training for childbirth into Britain.

The home birth lottery

A Guardian article (08/09/04) featuring the 'postcode lottery' in access to home birth services. The case of Paul Beland at Peterborough is discussed.

Parent trap

Negative attitudes to teenage mothers, and a YWCA campaign to change attitudes, are featured in this Guardian article (08/09/04).

Recent days have seen extensive coverage of alcohol misuse issues:

A Guardian article, Binge drinkers 'risk babies with birth defects' (13/09/04) highlights the risks of FAS (fetal alcohol syndrome) incurred by young female binge drinkers, who may not realise that they are pregnant.

The BBC News site of 06/09/04 featured a Tommy's/NOP survey which shows that a large proportion of pregnant women are ignoring advice from health professionals, as 1 in 5 women smoked and 2 out of 5 drank alcohol during their pregnancy: Pregnancy not curbing bad habits. The survey also revealed extensive ignorance about diet and other lifestyle issues. Tommy's is publishing a book, 'Tommy’s guide to pre-pregnancy care’ , which is available free during September at larger Boots' branches.

Another BBC News feature on 13/09/04, Any alcohol a risk during pregnancy, highlights a presentation by Raja Mukherjee at the Foetal Alcohol Syndrome Aware UK conference. According to Dr Mukherjee, many children who develop behavioural problems as a result of exposure to alcohol in the womb are incorrectly diagnosed as having conditions such as attention deficit hyperactivity disorder. The real culprit, alcohol consumption, goes unnoticed in these milder forms, collectively called Foetal Alcohol Spectrum Disorder. He is of the view that there is no safe limit for alcohol consumption during pregnancy.

Perinatal depression among black Caribbean women

Edge, D et al. Health & Social Care in the Community 12(5) 430f. 2004

I do not normally feature in this blog articles that are not available free. However, it seemed to be worth making an exception for this one.

This study showed that black Caribbean ethnicity is an important dimension in understanding the social patterning of mental illness. The findings have implications for the equitable provision of primary care services since black Caribbean women experienced depressive symptoms in pregnancy and early motherhood, but were less likely than their white British counterparts to receive treatment.

Why must we feel guilty?

An article by Lucy Cavendish in the Evening Standard of 31/08/04 about her experience of home birth. She argues strongly that it should be available to everyone.

Help for women suffering years of childbirth trauma

A report in the Telegraph of 31/08/04 about the setting up of the newly-founded Birth Trauma Association. The association supports women suffering from PTSD and offers support and advice to others who find it difficult to cope with their childbirth experience.

New mums need more old hands

According to Rowan Pelling in the Independent of 29/04/04 , midwives can no longer cope with long hours, low pay and the incompetence that surrounds them.

NB this article is now available only to subscribers or on a pay-per view basis.

Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome, by Smith GCS et al. New England Journal of Medicine 351:978-986 2004

A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor of the risk of unexplained stillbirth. There is a direct association between second-trimester maternal serum alpha-fetoprotein levels and the risk of SIDS, which may be mediated in part through impaired fetal growth and preterm birth.

The research is featured in a BBC News article.

The baby business

The Independent of 02/09/04 carries an extended article by Beryl Dixon about midwifery as a career. The RCM is mentioned several times.

Test may prevent premature births

Gravett and Nagalla at Oregon Health & Science University (OHSU) claim to have discovered a method for detecting intra-amniotic infections in pregnant women using state-of-the-art methods, according to the BBC News web site. They foresee that the finding may result in the development of a test for these hard-to-diagnose but common infections during pregnancy. Their research was published in JAMA.

Warning of near-term birth 'risk'

The BBC News web site highlights an article by Wang et al. published in Pediatrics, claiming that babies born just slightly prematurely have more health problems than those born at full term. They found conditions such as jaundice and hypoglycaemia were more common in babies born at 35 or 36 weeks gestation than those born at 37 weeks or more.

Brown et al. claim, in an article published in Archives of General Psychiatry, to have found that a dose of flu in the first half of pregnancy was linked to a three-fold increase in the risk of schizophrenia. However, illness in the second half of pregnancy seemed to have no effect.

These findings represent the strongest evidence thus far that prenatal exposure to influenza plays a role in schizophrenia. The researchers estimate that 14% of schizophrenia cases may be linked to exposure to the flu virus in the womb. Their work was highlighted on the BBC News web site on August 3rd.

Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial

Collins et al. ran this RCT with a group of 319 preterm infants to determine the effect of artificial teats (bottle and dummy) and cups on breast feeding. They found that cup feeding significantly increased the prevalence of fully breast feeding on discharge home but had no effect on any breast feeding and was associated with longer stays in hospital. Use of dummies did not affect breast feeding and did not affect length of stay.

Caesareans: a 'clarification' from NICE

According to an article in the Guardian of 22/08/04, pregnant women will have the right to a caesarean birth on the NHS even if there is no medical reason for it, say government experts who have backtracked from plans to restrict the operations.
The National Institute for Clinical Excellence (NICE) has issued a clarification of a recommendation it sent out earlier this year, which was aimed at curbing the soaring rates of caesareans. It told patients' groups that a woman's decision should be respected, even if two doctors disagree with her request for a caesarean.

Rise in number of stillbirths prompts inquiry

The Daily Telegraph of 20/08/04 reports on the increasing number of stillbirths and neonatal deaths. According to recent Office for National Statistics (ONS) figures, the total has risen in England and Wales for the second consecutive year: there were 3,585 stillbirths in 2003 - up 213 on 2002 - and 1,734 deaths at ages less than seven days - up 114. The DH and NICE are to hold an investigation into possible causes. Factors suggested include a trend in older mothers; whether more women are arriving later at hospital once they go into labour; infection rates among newborns; the national shortage of midwives; and the type of midwifery care women receive. It is known that risk factors include single parenthood and previous caesarean births.

Campaigns bring fewer cot deaths

The Telegraph also reports on the fall in the number of sudden infant deaths (cot deaths) recently announced by the ONS. There were 175 cot deaths in 2003, down from 192 in 2002, a fall of 13%. The figures do not, however, include deaths where the cause is registered as "unascertained". This story is also featured by BBC News.

Babies' deaths were 'unavoidable'

BBC News features an investigation by McIntosh et al. at Edinburgh University of 137 neonatal deaths occurring in Scotland over a two-year period, which concluded that the majority of the babies had suffered brain damage in utero which was neither preventable nor predictable. There were no indications of obstetric or midwifery malpractice, nor of parental failure to report and act on symptoms. The study was funded by the Chief Scientist Office and by the reproductive health charity WellBeing.

Maternity unit blood mix-up risk

The BBC News site features a recent article. Maternity staff have been urged to take extra care over labelling blood samples after warnings that mix-ups could put mothers and babies at risk, claims Jan Green in an editorial in the British Journal of Midwifery (12:8 2004). The recent publication of the Serious Hazards of Transfusion (SHOT, 2003) report highlighted that 75% of reported incidents were related to an incorrect blood component being transfused. This reflects a 25% increase in the number of reports from the previous 12 months. Approximately 30% of these incidents were due to mislabelling of samples.

The Royal College of Midwives comment is included: "We fully endorse the use of NHS number for babies to reduce the risk of confusion between blood samples taken from the mother and the baby. Mothers and babies should be reassured that their safety and well- being is of paramount importance."

Common antiepileptic drugs in pregnancy in women with epilepsy (Cochrane Review): Adab et al.

A substantive amendment to this review was published on May 26th 2004.

The reviewers conclude: based on the best current available evidence, it would seem advisable for women to continue medication during pregnancy using monotherapy at the lowest dose required to achieve seizure control. Polytherapy would seem best avoided where possible. More population based studies adequately powered to examine the effects of in utero exposure to specific monotherapies which are used in everyday practice are required.

"Midwives bought food as baby died"

The BBC web site's account of circumstances surrounding the death of Caitlin Coyne at the Royal Cornwall NHS Trust in February 2004. The BBC had obtained a copy of the independent review panel's inquiry report.

Results of a study by Thornton et al. in last week’s issue of The Lancet suggest that delaying delivery by a few days is as effective as immediate delivery for babies who have experienced fetal trauma. The study also showed that fetuses delivered without delay at 30 weeks or younger had an increased risk of infant disability compared with delayed delivery.

Factors affecting the performance of maternal health care providers in Armenia

A rare HR article, albeit one relating to a rather exotic setting, by Fort and Voltero, published in Human Resources for Health 2004, 2:8.

Over the last five years, international development organizations have begun to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affected the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia.

Pregnancy and autoimmune diseases

In an article in Best Practice and Research Clinical Rheumatology (18:3 2004 359-379) Caroline Gordon, a rheumatologist, outlines the pregnancy risk issues. Until about 15 years ago, the general advice to women with autoimmune rheumatic diseases, especially systemic lupus erythematosus, systemic sclerosis and vasculitic syndromes, was to avoid pregnancy as there was a high risk of maternal and fetal morbidity and mortality. However, it is now clear that these risks can be reduced in general by avoiding pregnancy when the diseases are active and continuing appropriate medication to reduce the chances of disease flare during pregnancy. The article reviews the evidence for this advice and also considers other issues that should be discussed with women before they attempt to become pregnant. This includes the influence of pregnancy on the individual autoimmune diseases.

Topical umbilical cord care at birth (Cochrane Review)

Zupan et al. have published an amended version of this review:

Findings: Twenty-one studies (8959 participants) were included, the majority of which were from high-income countries. No systemic infections or deaths were observed in any of the studies reviewed. No difference was demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord.

Conclusions: Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.

Obesity a danger to the unborn child

Research by Corcoy et al. published in the journal Diabetologia is highlighted by an article on the BBC News web site for 19/07/04. The researchers looked at the relationship between the mother's blood sugar levels and weight and birth defects in more than 2,000 children born to women with gestational diabetes. The mother's degree of obesity, measured by body mass index, appeared to be the main predicting factor for heart defects in the unborn child. It was the only factor that predicted whether the baby was likely to be born with kidney and urinary tract problems.

In his Own Words: The Midwife

An interesting article in the Guardian of 27/07/04 by David Cunningham on his experiences of working as a midwife.

Conquering the divide

Saba Salman in the Guardian of 30/06/04 reports on the work of a Sure Start centre in rural Lincolnshire.

Hospitals failing nursing mothers

A report in the Guardian of 06/07/04 discusses the findings of the UNICEF report on support for breastfeeding, which is strongly critical of UK hospitals.

Pregnancy and childbirth are leading causes of death in teenage girls in developing countries

Complications from pregnancy and childbirth are the leading cause of death in young women aged 15 to 19 in developing countries, according to a report published last week, the fifth annual State of the World's Mothers report, published by the international charity Save the Children. An estimated 70 000 adolescent mothers die each year because they have children before they are physically ready for parenthood, the report says.

Hospital admits stillbirth mistakes

Reporting on the recent case in Bishop Auckland where an unborn baby died after the mother had to be transferred 12 miles by car between maternity units owing to the non-availability of an ambulance.

Significantly, the report includes the following:

"Robert Aitken, the trust’s medical director, said: “The [trust's] review [of the incident]has identified two failings. Mrs Harrison was told she was eligible to give birth at the maternity unit at Bishop Auckland General Hospital. This advice breached the unit’s own clinical guidelines. When it became clear . . . that Mrs Harrison required transfer, the unit’s guidelines say that an ambulance should have been arranged to take her there. No ambulance was requested for her."

Forceps delivery in modern obstetric practice

Roshni R Patel, , Deirdre J Murphy

The authors conclude that:

Practice guidelines and protocols may help to ensure safe and consistent obstetric practice. Forceps delivery may offer advantages over caesarean section, but only if short and long term health benefits can be shown, including the potential for future uncomplicated spontaneous vaginal deliveries. Further research is required to evaluate women's overall reproductive outcome and satisfaction with the birth experience. The challenge for obstetricians is to make sure that options for safe delivery are not limited for women who experience complications in labor.

Report warns of continuing violations of code on breast milk substitute marketing

Many manufacturers of breast milk substitutes continue to violate an international code on marketing, a new report published last week says.

The report analysed the promotional practices of 16 international baby food companies and 14 bottle and teat companies between January 2002 and April 2004. It was published by the International Baby Food Action Network, a coalition of public interest groups working to reduce infant morbidity and mortality, as part of its ongoing monitoring of compliance with the international code of marketing of breast milk substitutes and relevant resolutions of the World Health Assembly.

Charity releases world's first guide on parenting deaf children 10 May 2004

The National Deaf Children's Society (NDCS) has produced the world's first interactive parenting guide for parents of deaf children by parents of deaf children.

Although some parenting skills are the same whether children are deaf or hearing, some issues are specific to parenting deaf children. These include: persuading children to wear their hearing aids when they don't want to, using props when telling bedtime stories, and soothing deaf children at night time if they are scared of the dark and can’t hear their parents' voices.

The CD-ROM, which includes tips from 30 parents on raising deaf children, is funded by a Family Support Grant from the Home Office. It is entitled Parenting a deaf child and shows film footage of deaf and hearing parents sharing their experiences in speech and British Sign Language (BSL). It is sub-titled and sign language interpreted.

It was created following research conducted by NDCS among 1,300 parents of deaf children. This found that there was no source of information anywhere in the world on bringing up deaf children.

The research found six key areas in which parents experienced difficulties, which are addressed in the CD-ROM:

· Supporting language and communication development
· Helping your child mix with others
· Warning your child of danger
· Managing frustration
· Dealing with emotions
· Building confidence and independence

A number of families were filmed for the CD-ROM, sharing information they had found helpful whilst bringing up their deaf children, and lessons they had learned. These include advice such as:

· Make an A-Z book of photos of activities to help children understand verbs. This could include everything from 'acting' to 'zipping'.
· Let your child choose fun, coloured hearing aids that they can be proud of.
· Make an 'activity board' that shows the child photos of things you often do as a family, such as getting in the car or going shopping. Then use it to ensure your child knows what is going on every day.

Irene Bell, mother of Robert, 16, said:

"I wish that we had had a resource like this available when Robert was little. You often feel as if you are the only person in the world whose child insists on feeding his hearing aid to the dog, but, of course, you aren't.

"Over the years I have really benefited from the experiences of other parents and I hope my contribution to this CD-ROM will be equally helpful to others."

NDCS project manager Kirsteen Coupar said:

"As 90% of the 35,000 deaf children in the UK grow up in hearing families a resource of this kind is vital. Historically there has been very little information available to parents to help them to cope with the challenges of raising a deaf child.

"This CD-ROM will share tips from the people who have the best experience – parents who have already successfully raised deaf children and learnt the lessons themselves."