midwifery dissertation examples uk

Best Midwifery Dissertation Topics Ideas & Examples

February 26, 2020

Dr Jana Martiskova

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Table of Contents

List of Midwifery dissertations Topics and Some Tips for Selecting Better Dissertation Topics in Midwifery

Many students feel difficulty in pursuing their studies in midwifery, let alone making a selection of topics for the dissertation. If you are searching for examples of midwifery literature review topics, midwifery research topics, midwifery dissertation titles, midwifery dissertation topics, or midwifery research questions this post is for you.

Do you belong to the above group of students who are not only shy but are also confused about how to make a selection of dissertation topics in midwifery for the midwifery dissertation?

Let’s first define what midwifery means and what its importance is in our social and medical structure.

What is Midwifery?

Midwifery is a healthcare profession that provides care to childbearing women during pregnancy, labor, and birth and during the postpartum period. They take care of the newborn and the mother. They also provide primary care to women which includes primary care to women, gynecological examination of women, family planning, and menopausal care.

In the nursing profession, students may be asked to write a dissertation on any topic of midwifery.

Tips for Selecting Midwifery Dissertation Topics

Like any dissertation in which it is difficult to choose a topic and write it, midwifery dissertations also students face the same problem. So, it is not an exception. However, one must know the important areas for the selection of the topic for the dissertation. Therefore, prior to the final selection of the topic, there are some important tips that would help students in selecting   midwifery dissertation topics. These tips are as follows.

• The students must be sure that they are going to discuss one of the most important topics in the subject.
• The dissertation on midwifery must touch on some of the serious problems which are faced by mothers and newborns.
• The students must take care that their topic is specific, and it is not broad in its nature.
• If someone has chosen a narrow topic, he/she must expand it through research and writing.
• Clear attention should be given to traditional midwifery dissertation topics in order to know their content and scope.
• The topic chosen must be aimed at explaining the profession in greater detail. The students choose the research topic which can help to improve the healthcare of mothers and their children.
• The students must enhance their basic knowledge for a better understanding of the subject.

Prenatal Care:

• The role of midwives in promoting healthy prenatal behaviors
• Assessing the effectiveness of prenatal education programs
• Addressing cultural barriers in accessing prenatal care

Postpartum Care:

• Strategies for improving postpartum support for new mothers.
• The impact of postpartum depression on maternal health outcomes
• Exploring alternative postpartum care models, such as home visits

Labor and Delivery:

• Examining the use of pain management techniques during labor
• Investigating the influence of birth environment on labor outcomes
• Evaluating the role of midwives in reducing cesarean section rates

Maternal Health:

• Addressing disparities in maternal healthcare access
• Exploring the impact of maternal nutrition on birth outcomes
• Investigating interventions to reduce maternal mortality rates globally.

Neonatal Care:

• Assessing the effectiveness of breastfeeding support in neonatal care units
• Exploring the role of midwives in neonatal resuscitation
• Investigating best practices for kangaroo care in low-resource settings

Women’s Health:

• Examining midwifery-led models of women’s health care
• Investigating the role of midwives in promoting sexual and reproductive health
• Addressing cultural taboos surrounding women’s health issues

Family Planning:

• Evaluating the impact of contraceptive counseling provided by midwives
• Exploring the role of midwives in providing abortion care
• Assessing barriers to accessing family planning services in rural areas

Midwifery Education and Training:

• Assessing the effectiveness of simulation training in midwifery education
• Exploring innovative teaching methods in midwifery programs
• Investigating strategies for mentorship and professional development in midwifery

Midwifery Ethics and Legal Issues:

• Examining ethical dilemmas faced by midwives in clinical practice.
• Exploring legal frameworks for midwifery practice across different countries
• Assessing the impact of litigation on midwifery practice

Mental Health in Pregnancy and Childbirth:

• Investigating the prevalence of anxiety disorders in pregnant women
• Exploring interventions for addressing trauma in childbirth
• Assessing the role of midwives in identifying and supporting women with perinatal mental health issues

Integrative Medicine in Midwifery Practice:

• Exploring the integration of complementary therapies in midwifery care
• Assessing the safety and efficacy of herbal remedies during pregnancy and childbirth
• Investigating cultural practices and rituals surrounding pregnancy and birth

Technology in Midwifery:

• Examining the use of telemedicine in midwifery practice
• Exploring the impact of mobile health applications on maternal and neonatal health outcomes
• Assessing the role of artificial intelligence in improving prenatal diagnosis and monitoring

LGBTQ+ Inclusive Care:

• Investigating the experiences of LGBTQ+ individuals in maternity care settings
• Assessing cultural competency training in midwifery education programs
• Exploring strategies for creating inclusive and affirming birth environments

Global Health and Midwifery:

• Examining the role of midwives in addressing maternal and neonatal health disparities in low-income countries
• Investigating the impact of international partnerships on improving midwifery services
• Assessing the cultural appropriateness of western midwifery models in diverse global contexts

Midwifery and Public Health:

• Exploring the role of midwives in promoting breastfeeding initiation and duration
• Assessing the impact of midwifery-led prenatal care on birth outcomes
• Investigating strategies for reducing maternal and neonatal morbidity and mortality through public health interventions

More Midwifery Dissertation Topics

In light of the above guidance, students can choose any topic from the following given midwifery dissertation topics.

• The impact of maternal obesity on birth outcomes
• The use of midwife-led continuity of care models in maternity care
• The role of midwives in promoting breastfeeding
• The use of technology in midwifery practice
• The impact of cultural diversity on midwifery care
• The use of midwifery-led care in low-risk pregnancies
• The role of midwives in reducing maternal mortality rates
• The use of telehealth in midwifery practice
• The impact of poverty on maternal and newborn health
• The use of water birth in midwifery practice
• The role of midwives in promoting maternal mental health
• The use of midwifery-led care in premature births
• The impact of the COVID-19 pandemic on midwifery practice
• The use of aromatherapy in midwifery practice
• The role of midwives in promoting gender equity in maternal health
• The use of midwifery-led care in home births
• The impact of policy changes on midwifery practice
• The use of midwifery-led care in rural and remote areas
• The role of midwives in promoting maternal and newborn nutrition
• The use of hypnobirthing in midwifery practice
• The impact of midwifery-led care on maternal satisfaction
• The use of midwifery-led care in women with complications in pregnancy
• The role of midwives in promoting maternal and child health
• The use of midwifery-led care in family planning
• The impact of the integration of midwifery practice and primary care
• The use of midwifery-led care in women with a history of trauma
• The role of midwives in promoting gender-sensitive care
• The use of midwifery-led care in low-income communities
• The impact of midwifery education on quality of care
• The use of midwifery-led care in women with chronic conditions.
• Role of a midwife: The role of the midwife in the present healthcare environments.
• Midwifery profession: Nursing and Midwifery-two identical yet different professions. Are they likely to go together? Or one will replace the other? What are the Prospects of males working in the midwifery profession?
• Improvements are needed in the midwifery profession in light of scientific developments in the health and childcare fields.
• The state of midwifery in developed and underdeveloped countries.
• Midwifery field: Discuss the latest practices in nursing and midwifery fields.
• The evolution of midwifery from ancient times to modern times.
• The relation between nursing and midwifery.
• The role of prenatal counseling in the growth of a child.
• Critical analysis of midwifery as the profession dominated by women.
• Midwifery service: How to improve midwifery services to less privileged women?
• What is the future growth of the midwifery profession?
• Pregnant women: Do the midwives influence decision-making and facilitate informed choices among pregnant women?
• Midwives’ descriptions and perceptions of pregnant women with problems of substance abuse .
• Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomized trial (the MidU study)

Midwifery is a noble profession with a lot of growth potential. There could be more thought-provoking nursing dissertation topics for research in this field. Interested in further details, call us for more Midwifery Dissertation topics.

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Guide for Students to Find the Best Midwifery Dissertation Topics

Table Of Contents

• What Does Midwifery Mean? | Significance in the Real World 

What Are the Steps to Writing a Midwifery Dissertation?

• 21 Latest Midwifery Dissertation Topics for Undergraduate
• 22 Trending Midwifery Dissertation Topics for Students

Unsure About Your Midwifery Dissertation Topics? Get Help

Finding the best midwifery dissertation topics is a challenging job for students. To overcome this issue, Assignment Desk experts have prepared this blog. It will provide you with all relevant information on how to choose midwifery dissertation ideas , some good topics to choose from, and how to start writing your dissertation.

As a midwifery student, you will be required to write your dissertation . Although the dissertation is a mandatory task, students need to complete this work if they want to pursue midwifery as an occupation. Before starting your dissertation, find a suitable topic that might interest you and write about it in detail. The challenge in this process is identifying the best dissertation topics in midwifery . Every student must have a clear understanding of this step of dissertation writing. So, let's start with the basics of midwifery.

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What Does Midwifery Mean? | Significance in the Real World

In this blog, we're going to look at midwifery and where it fits in with our society today. As you may know, there's still some debate about its meaning. We'll dive into the best midwifery dissertation titles .

The word "midwife" is a little hard to define. It's derived from the Latin word "mater," which means "mother." Midwives are those who offer maternity care and health services. Midwifery is a caring occupation that strives to preserve natural childbirth, prevent maternal death, reduce maternal morbidity and mortality, and improve perinatal outcomes.

Some still use it about a woman who gives birth, while others use it as a slang term for childbirth education and training. It can be unclear because many women wish to become midwives even though they still need formal educational credentials.

Midwives are one of the oldest professions in human history. They care for women, children, and families through childbirth every year. The definition of midwifery means "midwife." The Greeks first used this term to describe women who helped with birth and prenatal care. This fact can be easily used in the dissertation structure to make it more realistic and trustworthy.

Midwives remain vital to our society because they help women maintain their dignity during labour. And help them make healthy decisions throughout their pregnancy.

All these facts about the oldest profession attract students to pursue it as a profession. They are so inspired that the most challenging job of finding midwifery dissertation topics and writing a dissertation is easy for them. It is because they follow a proper procedure to do so. In the next section, you will learn more about that procedure.

While writing a dissertation on midwifery, it's important to remember that time is of the essence. You need to make sure that you complete and prepare a perfect dissertation on time and in an efficient manner that also makes it meaningful.

Here are some tips for students who want to write their midwifery dissertation. Or they can also seek a lot of help from these tips and tricks to improve dissertation writing skills .

• Writing an outline is the first step of any dissertation writing. Starting with this sections of your dissertation will make it easily formatted.
• Create a timeline. The timeline should include all the significant steps and milestones you must pass to complete your midwifery dissertation on time.
• Each section should be divided into smaller subsections, each with clear midwifery dissertation topics UK and a relevant purpose for your research.
• When you have your outline, you can begin writing. One of the best ways to get started is by writing down everything that comes to mind about each section. Then begin with the formal content planning.
• Now, look at the resources available on your midwifery dissertation topics : books written about it, articles published in journals or magazines, and videos or documentaries about caregivers.

Try using a checklist before starting this dissertation phase so you remember essential steps to include in the content!

Now that you have all these tips and tricks, it's time to start finding suitable and interesting midwifery dissertation topics . With a little bit of planning and some effort, you'll be able to complete this on time!

21 Latest Midwifery Dissertation Topics for Undergraduate

We have listed some of the best midwifery dissertation ideas to help you find a good topic that suits your research.

• Midwife experiences with asylum seekers' maternity care
• What causes pregnancy fear, and how can midwives help women?
• Uses, expectations, perspectives, and experiences with birth plans
• Pregnancy, childbirth, and IPV relationships
• Increasing normalcy with midwifery care: aquatic births
• Fathers' postnatal depression
• Antidepressants and postnatal depression
• During the postnatal period, it reduces pain and infection and promotes healing of the sutured perineum
• Enhanced maternal safety in the Philippines
• Pediatric, obstetric, and clinician-indirect home interventions for the Medicare population
• Nurses and midwives manage hypoglycemia in healthy-term newborns
• A comprehensive assessment of the qualitative literature on the experiences of health workers in acute hospital settings with teamwork education
• A comprehensive assessment of the experiences of midwives and nurses working together to offer childbirth care
• How have "care pathway technologies" affected integrating services in stroke care? And how strong is the evidence for their success in this area?
• Our nation has a midwifery culture
• Knowledge of gender in midwifery
• Early midwives among the Native Americans: the art of midwifery
• Midwifery trends happening in the nursing practice
• What role does midwifery play in society?
• Relationship between women and midwives and childbirth education in your nation.
• Midwives have experience with difficult deliveries

Choose dissertation topic from the above-mentioned examples and make your efforts worthwhile. After a deep analysis, our expert has curated these ideas for you to save time. You are only required to pick the one that interests you and start working on it. if still, these 21 titles are not as per your expectation, then below are more dissertation topics in midwifery available for your help.

Also Read:  How Long Should a Dissertation Be?

22 Trending Midwifery Dissertation Topics for Students

We understand how difficult it is to research a suitable topic for academic dissertation writing. Keeping that in mind, we have asked our team of professional writers with years of experience to create some of the most sensible midwifery dissertation topics UK with the help of trends. These will give you a good idea of the current issues confronting midwifery.

• The cause of recurrent miscarriage
• The cultural perspective on male midwives
• Effectiveness of DNA testing in diagnosing a child's hereditary condition
• Surgical success in treating an umbilical hernia
• What hereditary factors contribute to miscarriage?
• The importance of eating well and being nourished when pregnant
• Treatment for a ruptured hernia
• Midwives' treatment of postpartum depression
• Miscarriages' underlying mechanisms
• Trends involving males who work as midwives
• What are the differences between pregnant women's expectations and birthing experiences?
• What dangers lurk in-home abortions?
• Why do umbilical cord hernias occur?
• What part do infections play in miscarriages?
• Techniques for promoting a normal birth during the second stage of labour
• Management of perinatal depression
• Perinatal treatment for disabled women
• Obese women are still able to give birth typically, right?
• Describe the variables that prevent natural birthing.
• How practical are the WHO perinatal recommendations?
• Taking care of hepatitis B while pregnant
• The right to pick one's birthplace

These interesting midwifery dissertation topics can impress your faculty and get you instant approval, as experts pick them personally. So, if you're having trouble with your dissertation, seek professional assistance and leave all of your worries to those who have done it before.

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As a midwifery student, you may require a dissertation to be written by an expert writer. Moreover, it might be necessary to outline the study and write your dissertation proposal. We can organise all the essential steps for you and provide strong online dissertation help .

Writing a dissertation in midwifery is a tough job that requires tremendous concentration, so it is always advisable to engage the services of a professional writer who can complete your dissertation on time. We do not just offer midwifery, but we also provide many other benefits on several subjects. You can also find assistance for Nursing dissertation topics or Nursing assignment help . So if you want help from experts, make sure you go to the Assignment Desk and only pay a nominal fee.

Anyone interested in learning different ways to write a dissertation and wants to explore its art can also contact us. We offer samples on many levels of assistance, such as assignment help or anything from medicine.

You cannot ignore the importance of midwives in today's world. A Midwifery dissertation topics will provide valuable insight into the field. If you have difficulty finding resources for your dissertation, remember that we are here to help! We create a multitude of dissertations from scratch just for you.

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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.

Related Links:

• Evidence-based Practice Nursing Dissertation Topics
• Child Health Nursing Dissertation Topics
• Adult Nursing Dissertation Topics
• Critical Care Nursing Dissertation Topics
• Dementia Nursing Dissertation Topics
• Palliative Care Nursing Dissertation Topics
• Mental Health Nursing Dissertation Topics
• Nursing Dissertation Topics
• Coronavirus (COVID-19) Nursing Dissertation Topics

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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Frequently Asked Questions

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.

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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.

Submit details of your doctoral thesis to be included in the RCM collection

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Department : Health Sciences Module co-ordinator : Ms. Helen Recchia Credit value : 40 credits Credit level : H Academic year of delivery : 2021-22 See module specification for other years: 2022-23 2023-24

Module will run

Module aims.

To provide the student with the opportunity to study an area of midwifery practice in depth, demonstrate critical reasoning and application of theory to practice.

Module learning outcomes

This module will enable the student to:

• Critically review in depth the research literature related to their chosen topic of study.
• Critically evaluate a range of theoretical and philosophical dimensions in order to contextualise their study.
• Integrate relevant theoretical concepts with reflections on experience.
• Critically reflect on the application of evidence based guidelines to practice in their chosen area of study.
• Present a major study, which demonstrates critical thought and the ability to synthesise knowledge from a range of appraised sources.

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Written feedback for summative assessment is provided on the standard proforma, within the timescale specified in the programme handbook.

Indicative reading

• Aveyard, H. & Sharp, P. (2017) A beginners guide to evidence based practice  (3rd ed). Maidenhead: Open University Press
• Aveyard, H., Sharp, P. & Woolliams, M (2015) A beginners guide to critical thinking and writing in health and social care  (2nd ed). Maidenhead: Open University Press
• Becker, L. (2015) Writing successful reports and dissertations . London: SAGE Publications Ltd
• Cottrell, S. (2014) Dissertations and project reports. Basingstoke: Palgrave Macmillan
• Cottrell, S. (2017) Critical thinking skills. (3rd ed) . Basingstoke: Palgrave Macmillan
• Wickham, S. (2015) 101 Tips for planning, writing and surviving your dissertatio n. www.sarawickham.com
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Home » Blog » Dissertation » Topics » Nursing » Midwifery » Midwifery Dissertation Topics List (30 Examples) For Your Research

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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Bradbury-Jones C, Sambrook S, Irvine F. Power and empowerment in nursing: a fourth theoretical approach. J Adv Nurs. 2008; 62:(2)258-66 https://doi.org/https://doi.org/10.1111/j.1365-2648.2008.04598.x

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Maternity matters: choice, access and continuity of care in a safe service.London: DH; 2007

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Furedi F. Culture of Fear Revisited, 4th edn. London: Continuum; 2006

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Gatward H, Simpson M, Woodhart L, Stainton MC. Women's experiences of being induced for post-dates pregnancy. Women Birth. 2007; 23:(1)3-9 https://doi.org/https://doi.org/10.1016/j.wombi.2009.06.002

Gibson WJ, Brown A. Working with qualitative data.Los Angeles and London: Sage; 2009

Gigerenzer G, Muir-Gray J. Better doctors, better patients, better decisions: envisioning health care 2020.Cambridge, Massachusetts: The MIT Press; 2011

Green JM, Coupland VA, Kitzinger JV. Great expectations: a prospective study of women's expectations and experiences of childbirth.Hale: Books for Midwives Press; 1998

Hallgren A, Kihlgren M, Norberg A, Forslin L. Women's perceptions of childbirth and childbirth education before and after education and birth. Midwifery. 1995; 11:(3)130-7 https://doi.org/https://doi.org/10.1016/0266-6138(95)90027-6

Heimstad R, Romundstad PR, Hyett J, Mattsson LA, Salvesen KA. Women's experiences and attitudes towards expectant management and induction of labor for post-term pregnancy. Acta Obstet Gynecol Scand. 2007; 86:(8)950-6 https://doi.org/https://doi.org/10.1080/00016340701416929

Henderson J, Redshaw M. Womens experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand. 2013; 92:(10)1159-67

Jay A, Thomas H, Brooks F. In labor or in limbo? the experiences of women undergoing induction of labour in hospital: findings of a qualitative study. Birth. 2017; https://doi.org/https://doi.org/10.1111/birt.12310

Johanson R, Burr R, Leighton N, Jones P. Informed choice? Evidence of the persuasive power of professionals. J Public Health (Bangkok). 2000; 22:(3)439-40 https://doi.org/https://doi.org/10.1093/pubmed/22.3.439

Jomeen J. Choice in childbirth: a realistic expectation?. British Journal of Midwifery. 2007; 15:(8)485-90 https://doi.org/https://doi.org/10.12968/bjom.2007.15.8.24388

Kirkham M. Informed Choice in Maternity Care.Hampshire and New York: Palgrave Macmillan; 2004

Kirkham M, Stapleton H. The culture of maternity service as a barrier to informed choice. In: Kirkham M (ed). Hampshire and New York: Palgrave Macmillan; 2004

Kitzinger S. Some mothers' experiences of induced labour (report from the National Childbirth Trust).London: Department of Health and Social Security; 1975

Levine C. Research involving economically disadvantaged people. In: Emanuel EJ, Grady CC, Crouch RA, Lie RK, Miller FG, Wendler D (eds). Oxford: Oxford University Press; 2008

Levy V. Maintaining equilibrium: a grounded theory study of the processes involved when women make informed choices during pregnancy. Midwifery. 1999; 15:(2)109-19 https://doi.org/https://doi.org/10.1016/S0266-6138(99)90007-4

Levy V. How midwives used protective steering to facilitate informed choice in pregnancy. In: Kirkham M. (ed). Hampshire and New York: Palgrave Macmillan; 2004

Lewis BV, Rana S, Crook E. Letter: patient response to induction of labour. Lancet. 1975; 305:(7917) https://doi.org/https://doi.org/10.1016/S0140-6736(75)93188-8

Maher J. Progressing through labour and delivery: Birth time and women's experiences. Women's Studies International Forum. 2008; 31:129-37

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Murtagh M, Folan M. Womens experiences of induction of labour for post-dates pregnancy. British Journal of Midwifery. 2014; 22:(2)105-10 https://doi.org/https://doi.org/10.12968/bjom.2014.22.2.105

Induction of labour.London: RCOG Press; 2008

Induction of labour [CG70].London: NICE; 2008

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Newburn M. Culture, control and the birth environment. Pract Midwife. 2003; 6:(8)20-5

Hospital Maternity Activity.London: Health and Social Care Information Centre; 2016

Nuutila M, Halmesmäki E, Hiilesmaa V, Ylikorkala O. Womens anticipations of and experiences with induction of labor. Acta Obstet Gynecol Scand. 1999; 78:(8)704-9 https://doi.org/https://doi.org/10.1080/j.1600-0412.1999.780808.x

Rees JT. A consideration of ethical issues fundamental to researching sensitive topics: substance use during pregnancy. Evidence Based Midwifery. 2011; 9:(1)16-22

Roberts LJ, Young KR. The management of prolonged pregnancy-an analysis of womens attitudes before and after term. BJOG. 1991; 98:(11)1102-6 https://doi.org/https://doi.org/10.1111/j.1471-0528.1991.tb15361.x

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Induction of labour: How do women get information and make decisions? Findings of a qualitative study

Annabel Jay

Principal lecturer (midwifery), University of Hertfordshire

View articles · Email Annabel

Hilary Thomas

Professor of Healthcare Research, University of Hertfordshire

View articles

Fiona Brooks

Professor of Public Health, Faculty of Health, University of Technology, Sydney Australia; and Professor of Adolescent and Child Health, University of Hertfordshire

Induction of labour is one of the most frequent interventions in pregnancy. While it is not always unwelcome, it is associated with increased labour pain and further interventions. Evidence from earlier studies suggests that induction is often commenced without full discussion and information, which questions the validity of women's consent. This study aimed to add depth and context to existing knowledge by exploring how first-time mothers acquire information about induction and give consent to the procedure.

A qualitative study into women's experiences of induction was undertaken, comprising 21 women, who were interviewed 3-6 weeks after giving birth following induction.

Information from midwives and antenatal classes was minimal, with family and friends cited as key informants. Midwives presented induction as the preferred option, and alternative care plans, or the relative risks of induction versus continued pregnancy, were rarely discussed. Women reported that midwives often appeared rushed, with little time for discussion.

Conclusions

Providers of maternity care need to devise more flexible ways of working to create time and opportunities for midwives to discuss induction in detail with women and to promote fully informed decision-making.

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), 2008 ; Cheyne et al, 2012 ).

Epidemiological evidence from numerous studies in Europe, Israel and the USA ( National Collaborating Centre for Women's and Children's Health (NCC-WCH), 2008 ) has shown a gradually increasing risk of perinatal mortality in pregnancies exceeding 40 weeks, although the absolute risk remains very low. These studies suggest that the potential health benefits to women and babies of inducing labour after 41 weeks outweigh the additional costs to the maternity care provider ( NCC-WCH, 2008 ). Where medical conditions such as pre-eclampsia or Type 1 diabetes exist, the dangers of continuing the pregnancy may not be controversial ( Cheyne et al, 2012 ); however, approximately half of all inductions in the UK are performed for uncomplicated, post-date pregnancies, where the risk of perinatal death is low (2-3 per 1000 births). In these situations, the risk of maternal morbidity resulting from induction is relatively high, compared to spontaneous labour ( NCC-WCH, 2008 ; Cheyne et al, 2012 ). In keeping with the principles of woman-centred care ( Department of Health, 2007 ), the decision to induce labour or continue with the pregnancy rests with the woman. NICE guidelines state that:

‘Women who are having or being offered induction of labour should have the opportunity to make informed decisions about their care and treatment, in partnership with healthcare professionals’ ( NICE, 2008: 4 )

There is evidence that many women welcome the offer of induction for post-dates pregnancy, through concern for the baby's wellbeing, because of physical discomfort or for social reasons ( Shetty et al, 2005 ; Heimstad et al, 2007 ; Gammie and Key, 2014 ; Moore et al, 2014 ; Murtagh and Folan, 2014 ). For others, however, induction represents a significant and unwelcome change to their anticipated trajectory of pregnancy and labour onset ( Gatward et al, 2007 ).

Literature review

Early UK studies identified a need for more information and involvement in decision-making relating to induction ( Kitzinger, 1975 ; Lewis et al, 1975 ; Stewart, 1977 ). Cartwright's UK-wide study of more than 2000 women found that approximately 40% of participants would have liked more information ( Cartwright, 1977 ). Despite the growing discourse on informed choice since the 1970's, recent studies continue to highlight these issues. A comparative survey of 900 Scottish women by Shetty et al (2005) found that 34.7% of women who had their labour induced perceived information to be lacking and noted a disparity between expectations of induction and women's actual experiences, particularly in terms of duration, pain and interventions. This suggests that the information women received about induction did not enable them to build realistic expectations ( Shetty et al, 2005 ). A mixed-methods study involving secondary analysis of data from more than 5300 women from across England identified a lack of information and involvement in decision-making about induction ( Henderson and Redshaw, 2013 ). Overseas studies have noted similar findings ( Nuutila et al, 1999 ; Gatward et al, 2007 ; Moore et al, 2014 ). However, evidence from the UK remains scarce and is mostly derived from quantitative research, limiting the emergence of knowledge to that which falls within the parameters of closed-question surveys. The present study therefore set out to add depth and context to existing knowledge by delving into the ways in which first-time mothers acquire information about induction, how and why they consent to the procedure and how they experience it. Findings from this study relating to women's experiences of induced labour have been published elsewhere ( Jay et al, 2017 ). This paper focuses on information and decision-making.

The conceptual framework underpinning this study centred on the notion of informed choice in maternity care. A qualitative methodology was considered the most appropriate means of obtaining insight into women's perceptions of choice and how decisions were made. The face-to-face interview method of data collection is widely regarded as one of the key tools of the qualitative researcher ( Barbour, 2008 ), as it allows for both depth and breadth of data. A semi-structured approach was adopted, using a flexible schedule of open-ended questions (such as ‘Tell me about how you made the decision to go for induction’), which allowed participants to control the extent of disclosure ( Rogers, 2008 ; Rees, 2011 ). Ethical approval was granted by the Health Research Authority, England (NHS National Research Ethics Service Committee South Central, Oxford A) and the local Research and Development committee.

Interviews were conducted during the autumn/winter of 2012/13. Participants, who were identified from the postnatal ward of a maternity unit in the south of England, consisted of primiparous, English-speaking women over the age of 18, who had experienced induced labour at or close to term. Multiparous women were excluded, since they might be expected to have acquired a broader knowledge of induction through personal experience or their expanded peer network. No distinction was made in respect of the reason for induction, but all women had been classed as low-risk at the start of pregnancy and none had requested induction. All women were living with husbands or male partners. The first investigator visited the postnatal ward once per week for 6 months. All women who met the inclusion criteria were approached via a senior midwife who was fully apprised of the study. Access was denied to women who were deemed especially vulnerable (such as those whose babies were sick or going to foster care). An information leaflet was offered and, after reading it, women who expressed an interest in participating were asked for their written consent to be contacted again 3-4 weeks after discharge. Women were assured of their option to withdraw from the study at any time without consequences for their subsequent care.

‘Providing information and preparing women for what to expect during induction key to informed choice, particularly where the risks and benefits are not easily quantifiable’

A total of 33 women consented to be contacted; however 12 were lost to follow-up, as they either could not be reached or declined to participate. Except for one participant, who opted to be interviewed by telephone, all women were visited in their homes by the first investigator, where the purpose of the study was verbally reiterated, with reference to the participant information leaflet. Written consent was obtained before commencing interviews. Confidentiality and anonymity in all stored data and publications was assured. Interviews lasted 30-90 minutes and were audio-recorded.

A field diary was used to facilitate reflexivity, by recording impressions and feelings after each interview and reflecting on how the researcher's position as a midwife, teacher and/or mother might influence data interpretation. Transcripts of audio-recordings were re-read three times, while listening to the recordings, to check for accuracy of transcription. Data were initially organised using a priori categories formulated from the interview questions, with new categories added as they emerged. The software package NVivo10 was used to create a hierarchical structure of categories and sub-categories, which were then re-grouped into themes using an iterative process, until all identifiable themes were exhausted ( Barbour, 2008 ; Gibson and Brown, 2009 ). A form of framework analysis was also employed, in which numerical instances of particular aspects of data were counted, helping to identify the most frequently reported events, feelings or perceptions. All data were anonymised, in accordance with the Data Protection Act (1998). In this paper all quotations are suffixed by pseudonyms and the reason for induction.

Key themes emerging from the findings of this study relate to the acquisition of information about labour induction, how women perceived choice and how they made the decision to accept induction.

Sources of information on induction

Family and friends were the most common sources of information, cited by two-thirds of participants. Impressions of induction were varied and sometimes contradictory. Increased pain in labour was most frequently mentioned, but there was little consensus on other aspects; for example, four women had heard that the onset of labour would be quicker than natural labour, while five believed it would take longer.

‘I just knew […] from having spoken to other mums and dads that it would artificially bring on the contractions … the one thing I did know was that it would all mean it would happen a lot quicker … and therefore it might be a good deal more painful.’

‘My mother had been induced … I didn't really know what it was, other than it was meant to be more painful than a natural birth and that they gave you something to make the baby come.’

Of the sample ( n =21), 14 participants had attended free antenatal classes led by midwives from the local hospital, while seven had attended fee-paying classes, chiefly those organised by the National Childbirth Trust (NCT), a national parents' charity. Some women had attended more than one type of class, but it was unlikely that any two women had attended the same class simultaneously. Several women were not sure whether their classes had covered induction and those who recalled information described it as not very memorable.

‘I don't remember a lot of detail though … nothing that really sticks in my mind.’

‘I don't think they did [mention induction] and if they did, I don't remember it … it wasn't memorable.’

There was no suggestion that information had not been comprehensible to any participant; however, some women reported that they had paid little attention, as they could not foresee induction happening to them. Midwife-led classes attracted less criticism than those run by the NCT:

‘NCT's very much “everyone has a perfect birth” and that's it … I mean, nobody had said that … inducing you actually makes the contractions more painful.’

‘In NCT … we spent half an hour drawing pictures of what we thought would help induce labour, so pineapple and raspberry leaf tea … Drawing pictures! We're all in our 30s, all professionals! […] I hadn't paid much attention, or the information wasn't there to be paid attention to.’

The maternity unit produced an information leaflet on induction, to be given out when induction was booked. Only 11 women reported reading the leaflet, while two stated that they had received it but not read it. It was not clear whether the remaining women had received a leaflet or not, but none reported having read it.

‘I've got so many leaflets I don't know what's what anymore! I don't remember reading one, but they might well have done, and I've missed it.’

Electronic media were mentioned by just seven women. Two women found helpful apps, whereas those who searched the internet often had trouble finding credible websites and relating the information to their own situation:

‘Obviously, you look on the Internet and there's so many … lots of horror stories … and other people were saying how it wasn't that bad … but it didn't really help me, because it was going to be my experience anyway!’

Several women consulted various sources:

‘A little bit from Google, a little bit from my sister […] because my midwife didn't explain a lot to me […] From, like, friends and family.

As in Tanya's case, information from midwives in the antenatal clinic was often perfunctory or limited to a leaflet, as midwives gave the appearance of being too busy to offer much explanation:

‘To be honest … I think she was quite busy, she always … just seemed a bit rushed, so we didn't really get to talk a lot but … yeah, I didn't really know anything!’

‘I think she assumed that I knew about it and I sort of didn't really get asked if I knew about it but … it was all quite a quick appointment, I think they had others waiting.’

Few women sought further information from midwives, as they saw no need at the time induction was first offered. With hindsight, however, many stated that they would have preferred to have known more, particularly regarding the duration and procedures.

Involvement in decision-making

Half of the women stated that they had been involved in the decision to induce labour; however, this tended to be little more than agreeing to a predetermined plan:

‘I was kind of part of the decision; I was there when she made the phone call to the hospital but it, other than that it was, “Oh, if you haven't gone into labour by this date then this is what's gonna happen” and that was, I was like, “Oh, OK.”’

‘[The doctor] told me to go to see the midwife at the desk who then gave me a leaflet to read while she went and booked it [the induction].’

Where induction was presented as an option, there appeared to be a bias towards compliance:

‘It was presented as a choice, but they were definitely encouraging me to strongly consider it rather than waiting.’

Nina, who had been planning a home birth, was highly resistant to the offer of induction for post-dates pregnancy and opted to defer the procedure, but found the stress of daily fetal monitoring overwhelming and eventually agreed:

‘They did say I could push my induction date back, but because I kept going in every day and all the stress […] when it came to it I was like, “Do you know what? Let's just do it, I can't deal with this stress any more.”’

The impression from most women was that, regardless of reason, induction was often presented as routine, with little or no opportunity for discussion and with compliance assumed.

Risk awareness

Many women alluded to the powerful influence that any mention of risk had on their decision to accept induction. Where medical conditions existed, women were generally clear about the reason for induction; conversely, in cases of post-dates pregnancy, perception of risk was often non-specific:

‘Um … no, basically it was … being induced really, because obviously I was that far overdue … they needed to get [baby] out I think.’

‘And it [an app] just says also about some of the risks if you are overdue, like past 42 weeks, about the baby's health and I think that's when I just thought, “Right, it needs to be now” and that was my paramount focus was [baby] being okay.

Trust in professional opinion appeared very strong, and risk was generally seen only in terms of dangers of prolonged pregnancy to the fetus, rather than risks to both the woman and fetus or neonate from proposed medical interventions.

‘I don't know anything about medicine; they're saying it's for my benefit and the baby's benefit, so I'll just go with whatever the medical people say.’

‘If medical professionals advise you that that's the best thing and the least risky thing, then, you know, you'd be very brave to do something different really.’

In all cases, concern for the unborn baby overrode women's previous aspirations for a natural birth experience, a phenomenon noted in earlier studies ( Roberts and Young, 1991 ; Heimstad et al, 2007 ; Moore et al, 2014 ; Murtagh and Folan, 2014 ). However, there was no apparent awareness of the statistical probability of harm.

Influence of partners

Partners were a significant influence on some women's decision to accept induction. Some reportedly viewed induction simply as a logical choice for the sake of safety and expediency, while others were impatient.

‘When I spoke to [partner], he was the one to sort of realise I needed a bit of a prod and, you know […] they're saying to you. “Baby is ready … so we need to do it.”’

‘I think my partner was more interested in it than me! I think he thought, … “Can we just like book it now?”’

The role of partners in the decision to accept induction has not been previously explored and is worthy of further study.

The NICE guideline and quality standards emphasise the need for a thorough explanation of the reasons for induction, the process, the relative risks and the alternative options ( NICE 2008 ; 2014 ). Evidence from this study indicates that women received very limited information during pregnancy and around the time that induction was booked—indeed many could recall little or nothing that was meaningful to them beyond anecdotes from friends and family. This contrasts with other UK studies that cite clinicians as the main information providers ( Shetty et al, 2005 ; Gammie and Key, 2014 ).

Only half of participants had reportedly read the Trust's information leaflet on induction. This lack of engagement may reflect information overload, which may also explain the apparent reluctance to seek information via the internet. However, it is possible that, having accepted induction as inevitable, women felt no need to enquire further, for fear of fuelling anxiety ( Hallgren et al, 1995 ; Levy, 1999 ). Moreover, it has been demonstrated that the high level of trust afforded to clinicians led many women to assume that whatever is offered must be in their best interests ( Kirkham, 2004 ; Sakala, 2006 ; Jomeen, 2007 ; Edwards, 2008 ). This may go some way towards explaining the apparent lack of enquiry.

The connection between knowledge and power is widely documented, and health professionals have power to control the release of information ( Johanson et al, 2000 ; Fahy, 2002 ; Bradbury-Jones et al, 2008 ). It has been argued that women without previous childbirth experience are unlikely to enquire about options that are not brought to their attention by clinical staff and are thus especially vulnerable to coercion ( DeVries et al, 2001 ; Newburn, 2003 ; Kirkham and Stapleton, 2004 ; Jomeen, 2007 ). Withholding information that may create dilemmas for women may be done for benevolent reasons (to avoid creating anxiety, for example) ( Levy, 2004 ). In this study, however, by failing to share knowledge about other options or to discuss the finer details of induction, midwives appeared to steer women towards induction and effectively suppressed autonomous choice.

It has been argued that too much information and responsibility for decision-making can have effects similar to those of insufficient choice, leading to a sense of anxiety and loss of control ( Green et al, 1998 ; Weaver, 1998 ). There were instances in this study of women (such as Rose) who chose not to seek information or opting to delegate decision-making to clinicians. This raises questions about the value that individual women place on information and decision-making, and whether they would have welcomed more information had it been offered.

Studies into the provision of childbirth information have highlighted the importance of appropriate timing of information-giving ( Stapleton et al, 2002 ; Maher, 2008 ; Cooper and Warland, 2011 ). Women's recall of detail about induction from antenatal classes suggests that they were unable to retain or assimilate that which did not seem relevant to them. In some cases, this may have been attributable to the presentation style of the class leader; however, by necessity, information given in antenatal classes is generalised and there may not be scope to address individual needs. Moreover, women typically attend classes early in the third trimester of pregnancy, well before the question of induction arises. This highlights a need for individualised and appropriately timed information in late pregnancy.

Only four women questioned the need for induction, and the majority agreed to the process without any discussion with health professionals, contrary to the recommendations of NICE ( 2008 ; 2014 ). Fear of harm to the fetus was cited as the chief influence; however, there was little evidence of risk evaluation having taken place, particularly where induction was offered for uncomplicated, post-dates pregnancy. Women need to be aware of the relatively low probability of mortality resulting from prolonged pregnancy, compared to the much higher probability of low-level of harm resulting from interventions following induction.

Poor understanding of probability is thought to be common among health professionals ( Furedi, 2006 ; Gigerenzer and Muir-Gray, 2011 ; Cheyne et al, 2012 ). Midwives need a deeper understanding of risk and probability, and the ability to convey this meaningfully to women ( Cheyne et al, 2012 ; Skyrme, 2014 ). Unless both sides of a risk argument are presented, any decisions made cannot be said to have been truly informed. Furthermore, midwives need to feel empowered to offer a balanced discussion of risk, safe in the knowledge that they will not be penalised if women choose not to comply with the expected norm ( Skyrme, 2014 ).

It is easy to attribute the lack of information and discussion to shortcomings in midwifery practice. However, in common with many UK maternity units, the system of care is based around short, task-oriented appointments, which compels midwives to control the agenda and limit discussion time to ensure that appointments do not overrun. This leads to a reactive, rather than proactive, approach to discussion ( Kirkham and Stapleton, 2004 ; Levy, 2004 ). It was noted that midwives often appeared busy and had others waiting, which may have inhibited women from asking questions.

Limitations

This study was conducted in a single NHS Trust. The sample was self-selecting and women from higher socioeconomic groups were over-represented: a factor common to studies of this nature ( Levine, 2008 ). For pragmatic and ethical reasons, women aged less than 18, those not fluent in English and those deemed vulnerable were excluded from the sample. There is a need for further studies to address the experiences of such women.

Conclusion and implications for practice

Midwives need to acknowledge that induction is often a disruption to women's expected trajectory of labour and birth. Providing information and preparing women for what to expect during induction is key to informed choice, particularly where the risks and benefits are not easily quantifiable. These findings suggest that a new approach is needed for the management of uncomplicated, post-dates pregnancy. Rather than steering women towards routine acceptance of induction, women should be given individualised information, taking account of their clinical status, social and cultural background and their desire for choice and information. Providers of maternity care may need to consider more flexible ways of working, allowing more contact time for women and midwives to discuss options in an unhurried and balanced manner. Additional measures could be considered, such as the use of decision aids, online resources or pre-induction classes. This may require the recruitment of more midwives or the adoption of alternative patterns of care provision, such as case-loading. Each will have budget implications for maternity units.

Midwives and doctors need to be able to engage with women in a balanced discussion of the relative risks of induction and expectant management. This implies a need for higher education institutions to emphasise the understanding and communication of risk and probability as part of their undergraduate curricula.

• This was a qualitative study that explored women's experiences of induction
• The women interviewed commented that family members and friends provided more meaningful information about induction than midwives
• Induction for post-dates pregnancy was presented as routine, with little or no discussion of other options
• To fulfil their duty to promote informed choice, providers of maternity care must therefore allow time and opportunity for a fully informed discussion of the options, risks and benefits of induction, taking account of women's individual needs.

CPD reflective questions

• Consider the women undergoing induction in your unit: do they mostly have a good understanding of the likely timescale and processes involved?
• Reflect on the last time you booked a woman for induction: what information did you offer? Do you think this was sufficient to enable a fully informed decision? If not, what was lacking?
• Consider the written information about induction that is provided by your unit. Do women read this? If not, why not? Would an alternative medium (such as an app) be more acceptable?
• How would you open a discussion about the relative risks and benefits of induction for post-dates pregnancy? What statistics might you need and where would you seek them?
• What further learning do you need to be able to confidently discuss risk and probability with your clients?

Midwifery: Literature searching

• Literature searching
• Referencing
• Organisations & Publications
• Help with Writing & Critiquing
• NHS Open Athens
• Disability, health and well being support
• Test your skills!

Literature Searching -there's lots of advice on this page.

Have a look at the videos and the information on this page. Planning a good approach to your Literature Searching will lead to better results and give you a stronger foundation for success in your assignments.

• Literature Searching -teach yourself the basics via our guide

Reminder: Please Log into My Unihub before using Electronic Resources

What is a literature search.

A literature search is a systematic and comprehensive search for information. This information will inform, underpin and /or shape your research. 

A literature search will help you to find out what has already been written in your subject area and identify the main trends. 

The information could be found in books, journal articles, reports, guidelines, case studies, policy documents, conference proceedings etc.

To do a full literature search you will need to use the recommended nursing academic journal databases. Online tutorials and help sheets for using the individual databases are also available. You also might need to look at NICE guidelines, the RCN, RCM, WHO and other official and professional organisations.

Remember, you must always be logged into  MyUniHub  first. That is how the databases know that you are from Middlesex University and that you don't have to pay!

Google Scholar is useful for citation searching (using sources cited in articles to lead to other sources) as it includes hyperlinks directly to cited sources. However, start with the academic journal databases that we subscribe to as in most cases you will get straight into the full-text. More information about citation searching can be found on the Open University website.

Watch our videos on the right about Literature Searching and why keywords are so important!

Search Tips

B efore you start searching:

It is useful to identify and list the key words and concepts you are interested in. This should include:

• Synonyms - words that mean the same or similar thing. Make a list. Authors may choose to use one particular term rather than another in their articles.
• Related terms and different word endings/plurals.
• If you are interested in a particular ailment, illness or health condition, identify the different names that are used for it - medical and more general (formal/informal).
• If you are interested in a particular treatment, identify the medication or treatment and the variety of names for it.
• Make a note of acronyms and abbreviations. Including these in your search strategy ensures you are doing a thorough search.
• Different spellings. American English spellings are worth including in your list of search terms.
• Keep a record of keywords and your search strategies. These are an essential part of your research. They need to be described and recorded in your final dissertation as proof of a systematic and thorough approach.
• Most databases allow you to create your own individual account where you can save your searches/results, print out the search strategy and set up email alerts to update you on up to date articles in your area of interest.

Once you start searching:

• Break your topic or research question into its component parts and search for each separately.
• Search using each term separately and look at the number of results to see which are most commonly used.
• Do this for each part or concept within your topic of interest or research question. This gives you more flexibility in the way you can combine concepts together at a later stage.

Combining searches with 'and' and 'or'

• Search using each term separately and look at the number of results to see which are most commonly used. You can later combine these using OR to include articles that contain any of the keywords, for a broad search. This is useful for synonyms, or terms that mean the same or similar.

        e.g. X OR Y OR Z retrieves results which have either term X or term Y or term Z.

• Keywords that broaden or narrow down your search. Combine these using AND to search for articles which include all terms to focus/narrow a search.

         e.g. Q AND R AND S retrieves results which contain all three terms Q, R and S.

• Spellings - Remember words may be spelt differently. Many databases have an international scope and the literature (and spellings) will reflect this.
• Additional Keywords - Articles, and search results (especially abstracts) may indicate additional keywords you may not have identified which you can add to your search strategy. You may modify your search strategy as your knowledge of your topic grows.

For more detailed advice and tips use the Search Tips for Midwifery Students help sheet. Books on research and literature reviews also explain the process of literature searching in detail.

Literature searching... and using CINAHL

Cinahl: focusing on uk content.

• Finding UK articles

CINAHL Basic Search

• Doing a basic search in CINAHL

CINAHL Advanced Search

• Advanced search in CINAHL

The link below takes you to a glossary which provides explanations of words and terms you may come across when using the library web pages and resources to complete your research.

• Words and meanings

Testing treatments website

This website is about why testing treatments rigorously is important and what YOU can do to promote better research for better health care.

• Testing treatments

A very brief intro to Literature Searching

A quick intro to Literature Searching on Biteable .

Finding and evaluating EVIDENCE for your assignments

EVIDENCE on Biteable .

A very brief video about Keywords

Let's think about keywords on Biteable .

Searching for UK focused articles

Searching for UK focused articles on Biteable .

Help Sheets

Helpsheets and worksheets from literature searching sessions

• Formulating a research-focussed question
• Identifying Keywords
• Developing your dissertation proposal (including PICO)
• Search Tips For Midwifery Students
• Combining searches using CINAHL/MEDLINE
• CINAHL Helpsheet
• Referencing Rex Says... examples of how to reference different materials
• How to read a research paper (Robin Parsons) Search for this article in the MIDIRS journal
• 'Qualitative' versus 'quantitative' - what is the difference? (Robin Parsons) more... less... Search for this article in the MIDIRS journal
• From practice to research This is a really useful article about PICO and PEO. Search for it in the MIDIRS journal.
• Try this Literature Searching quiz
• << Previous: Finding Journals and Journal Articles
• Next: Referencing >>
• Last Updated: May 30, 2024 11:52 AM
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I'm stuck. Choose me a midwify dissertation topic.

EccentricaGallumbits · 30/09/2009 12:02

Things I like Normal birth Water Art Placentas Knitting. TIA.

The role of the knitted placenta in art.

also there has to have been at least 10 research papers already done on said subject.

Homebirth - is it an unacknowledged feminist stance against the male-dominated hegemony of the obstetric unit? !!

Interested in this thread?

Then you might like threads about this subject:

Aha...that's where my idea comes unstuck I suspect

...and knitting

Antenatal preparation and mode of birth? I thankfully escaped a dissertation, but sometimes wonder, if I had to...then shudder, and have a cup of tea.

Can't you do your own research? If I wasn't so lazy and could motivate myself to do my dissertation I'd want to do some research. I was thinking about doing research on partnerss feelings about the birth. But then I realised I wouldn't have enough time for Mn'ing and decided to stick at a diploma.

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Breech presentation in pregnancy and the demise of knowledgeable clinicians available to assist with vaginal birth.

who the bloody hell thought it would be a good idea to do this to myself? am sorely tempted to jack it in and go back to nursing.

not enough time / energy for primary research. Has to be literature review. Breech is tempting. Perhaps something about whether nurses make better midwives or not. spirituality ad birthing? but what focus?

Do women need spiritual care from midwives? Spirituality, midwifery and childbirth in the UK?

Spirituality of midwives and its impact on maternal care Does midwives' experience of water-assisted birth affect their attitudes towards it? (could you manage a questionnaire as well as a literature review?) Like the 'Does previous nursing training affect midwives' practice?' idea.

Im a mental health nurse (with interest in perinatal mental health). I did my dissertation on Post Traumatic Stress Disorder following childbirth. Quite a few 'recent' (from 1994) papers out there.

Or what about ante natal care in prisons?

Still haven't decded. I really don't want to do something tat will traumatise me for the next 10 months so things like PTSD, emergencies and cappitity while interesting are out. I'm wondering about language used by midwives / medical peeps, whether women mind us talking bollocks a different language? whether women have jargo or medical / professional terms explained? and if it makes a difference to their experience? what do you think?

how about hypnosis & birth? there's some research going on in Adelaide at the moment Think the language issue a good one... interesting how rhetoric is used to manipulate choices ie get women so afraid they will agree to whatever medics want.

EccentricaGallumbits I'm being a bit cheeky (hijack) but can I just ask you, your a nurse, yes? Did you train as a nurse with midwifery in mind to do after initial nurse training, and do you think that it has benefited you by doing the nurse training first? Sorry lots of questions it's just I have started an access course to do nursing/midwifery....slightly undecided which pathway and am applying now to uni's. Any advice would be amazing......

pnd incidence related to birth experience Or, is it helpful to tell women they are not in labour until 2cm dilated?

cultural issues, esp as affecting women who are displaced, like asylum seekers? tho' might be a bit traumatic. I'd like a quick hijack, too- having a midlife crisis and considering long term dream of mw training? good idea or not?

well can you knit your own stretchy cervix and birth canal?

Hokay. Hijackers! I did always have an incling to do midwifery. I did nursing first because a. there was a nursing campus near me and the DDs were littler so less travelling. b. direct entry midwifery is hellishly competetive to get into so thought nursing might give me a leg up on the way (it did) c. I wasn't completely sure about the midwifery so thought having nursing as a base would be a good start because you an do lots of stuff, specialisms, etc from it. I am very glad I did nursing first because I actually love nursing, just don't like the crappy beurocracy that goes with it. not that midwifery is any different in that way but there are other options and a different supervision system. The nursing bit does help hugely when actually working in maternity. You have a more rounded view of medicine, surgery, physiology, pain, communication, psychology, sociology etc etc. However that's not to say that all that stuff isn't covered in the 3 year course. I think it just helps being more practiced in it before you start. If you do consider the nursey bit first then it may be useful checking with local universities if they do the 18 month conversion because lots don't and you may have to commute miles. And finally perfect for a midlife crisis career change. I have to say that. Thanks for suggestions. keep them coming. Am liking the decision making angle to the language thingy.

and yes. i have been known to knit uteri

hellishly competitive have to say I made a rather fine placenta out of felt with dressing gown cord covered with tights as umbilical cord (when I was nct teacher) I had this idea that 'visual' aids should be homely, would be more empowering...so...if you have knitted a uterus, what about something on women's understanding of physiology, how that relates to their exp of labour? prob no primary research on this tho. love your name btw.

(yes, hijacking again) Just wondering how you managed studying nursing with little children. i am considering a nursing degree but don't know how on earth i would make time for my 4 kids!?

post-traumatic stress incidence following instrumental delivery and impact on postnatal depression and/or bonding with baby

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Library Guides

Nursing and Midwifery

• Accessing NHS resources
• Journals, Databases and Critical Thinking

What is a literature review?

Choosing a topic, developing your search strategy, carrying out your search, saving and documenting your search, formulating a research question, critical appraisal tools.

• Go to LibrarySearch This link opens in a new window

So you have been asked to complete a literature review, but what is a literature review?

A literature review is a piece of research which aims to address a specific research question. It is a comprehensive summary and analysis of existing literature. The literature itself should be the main topic of discussion in your review. You want the results and themes to speak for themselves to avoid any bias.

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.
• Think about why the topic is worth investigating.  

Once you have decided on a topic, it is a good practice to carry out an initial scoping search.

This requires you to do a quick search using  LibrarySearch  or  Google Scholar  to ensure that there is research on your topic. This is a preliminary step to your search to check what literature is available before deciding on your question. 

The research question framework elements can also be used as keywords.

• Think about who the population/ sample group. Are you looking for a particular age group, ethnicity, cultural background, gender, health issue etc.
• 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!

• << Previous: Journals, Databases and Critical Thinking
• Next: Go to LibrarySearch >>
• Last Updated: Apr 18, 2024 12:13 PM
• URL: https://libguides.gre.ac.uk/nursing

Library policies | Library Code of Conduct | IT Service Status | Portal © University of Greenwich | FOI | Privacy and cookies | Legal | Terms & conditions

• Introduction to Academic Resources
• How to run your search
• Finding Books
• Finding Journal Articles
• Finding policy papers and other evidence sources
• Evaluating Health Sources
• Keeping track of your sources

Support with your academic writing

Copyright guidance, what is referencing and why do i have to do it, referencing at uws.

• Research resources
• Academic Skills See the Academic Skills site for videos, podcasts and other resources to help you with your academic writing, presentation skills and other study skills. You can also book an appointment here to discuss your work with an Academic Skills Advisor.
• Academic Phrasebank Explore University of Manchester's Academic Phrasebank for suggestions to link your ideas together, describe common academic concepts and alternative phrases to give your writing added variety.

Copyright legislation protects creative ideas and publications and affects us all.  There are though several exceptions to copyright law in the UK which apply to information used for educational purposes.  These are known as fair dealing  and are set out in the Copyright at UWS guide:

Private study exception  - allows individual students to copy extracts from material for their own reference purposes:

• One article from any one issue of a journal.
•  One chapter or up to 5% (whichever is greater) of a book.
• One poem or short story of up to 10 pages from an anthology.

Non-commercial research exception

• One legal case report allows individual researchers to copy extracts from material for their own reference purposes.

Quotation, criticism or review – allows students, researchers and staff to quote short extracts from copyrighted works in essays, reviews and journal articles.

• A single extract of no more than 400 words.
• A series of extracts of no more than a total of 800 words, with no single extract exceeding 300 words.

Creating accessible copies for disabled users – allows individuals to copy work in accessible formats (i.e. adapting work into braille or adding subtitles):

• Personal copies of entire documents may be made provided for disabled learners as long as a copy of the document is owned by the institution, the author of the work is acknowledged and a statement is included that the copies are made under Section 31B of the CDPA.

[CDPA refers to Copyright, Designs and Patents Act 1988 ].

• Library Guide Copyright at UWS

Referencing is the method we use to acknowledge the work of other authors.

It serves three principal aims:

• To support your arguments with evidence. Referencing demonstrates that your own arguments are grounded in a body of existing research and have been developed through an examination of the relevant literature.
• Referencing is an important means by which we credit other authors for any ideas, arguments, quotations, and other forms of intellectual property which are not your own. Not providing an acknowledgement for the work of others is considered plagiarism (note that plagiarism can be both intentional and unintentional). You must always provide a citation when you use another author's intellectual ideas, whether you are paraphrasing (putting it into your own words), summarising, or directly quoting from the source.
• Referencing shows the reader where they can access the original sources you have used (the evidence) to verify or fact check. It also helps the reader to carry out additional research of their own.
• Referencing at UWS See our local Referencing at UWS guide for a brief introduction to adding in-text citations, creating references and using the Cite Them Right Online website.
• Cite Them Right Online Login to Cite Them Right Online, access the Tutorial to learn about referencing, quiz yourself on your knowledge, explore multiple referencing examples and use the 'you try' feature to generate accurate references for your sources. more... less... Login with your university email and password.
• << Previous: Keeping track of your sources
• Next: Research resources >>
• Last Updated: May 17, 2024 1:29 PM
• URL: https://uws-uk.libguides.com/Midwifery

• Research article
• Open access
• Published: 17 September 2018

Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda

• S. Dixon   ORCID: orcid.org/0000-0002-7469-6093 1 ,
• K. Agha 5 ,
• L. El-Hindi 5 ,
• B. Kelly 4 ,
• L. Locock 1 , 2 ,
• N. Otoo-Oyortey 7 ,
• S. Penny 8 ,
• E. Plugge 3 &
• L. Hinton 1  

Research Involvement and Engagement volume  4 , Article number:  29 ( 2018 ) Cite this article

21k Accesses

11 Citations

14 Altmetric

Metrics details

Female Genital Mutilation (FGM) is all practices involving cutting, alteration or injury to the female genitalia for non-medical reasons. It is a form of violence against women and children, with no benefits and many harms. In 2014, the UK Government committed to working to eliminate FGM. Steps taken towards this aim included creation of educational and safeguarding resources for professionals, and legislative changes including a mandatory reporting duty for professionals in England and Wales (where if a girl under 18 discloses or is found on examination to have FGM then the professional is mandated to report this to the police), and an FGM Enhanced Dataset applicable to NHS organisations in England requiring the submission of personal data about women and girls who have had FGM to NHS Digital. To date, compliance with dataset returns from primary care services have been low. This report describes using patient and public involvement (PPI) to identify research and service priorities to support communities affected by FGM.

We held a series of PPI events (4 focus groups, and a multi-agency seminar) in 2015–2016, following the introduction of these legislative changes, speaking to community members, and professionals involved in their care. We asked participants to consider what they identified as research, knowledge and service priorities to support communities affected by FGM.

The impact of these legislative and reporting requirements on the trust needed for community members to seek to consult health services was identified as important for further research. Priorities for service development were holistic services, that met a woman’s needs throughout her lifecourse. Participants emphasised the importance of understanding how to listen, involve and utilise community voices in developing education for professionals, designing services, and developing policy.

Conclusions

There was a desire for change to develop from within affected communities; any learning and resources need to be co-created and constructed in such a way that they can be effectively shared between women, communities, and professionals. Questions remain about how to define community consultation, how to recognise when it was adequate, and how to hear beyond community activists to hear a wider range of voices.

Peer Review reports

Plain English summary

Female genital mutilation (FGM) refers to a set of practices involving cutting, alteration or injury to the external female genitalia for non-medical reasons. With no known health benefits, FGM is often associated with immediate and long-term health complications. Over 200 million girls and women worldwide are living with the effects of FGM. Every year 3 million girls and women are at risk of being cut and exposed to harmful health consequences. Globally FGM is concentrated in sub-Saharan African countries from the Atlantic Coast to the Horn of Africa, but women in other countries including Iraq, Oman, Yemen, Indonesia and Malaysia, are also affected. Global migration means FGM is now a worldwide health issue.

In the UK, there is increasing awareness of the importance of FGM as a health and safeguarding issue. There are many communities living in the UK who originate from countries where FGM is practised. Every local authority area is likely to have women and girls who are affected or potentially at risk. FGM has been a crime in the UK since 1985, and the government is committed to eliminating it. Recent legal changes now make it compulsory for doctors, teachers and other regulated professionals to report directly to the police when anyone aged under 18 makes a first hand disclosure of FGM or FGM is found on examination, and for English NHS health organisations to submit data to NHS Digital about women and girls they have seen who have experienced FGM.

Research on the effects of FGM on women and communities in England is limited. In particular, we know little of affected communities’ knowledge and understanding of these new legal changes, and how this might impact on people’s willingness to go to their doctor. Nor do we know how health professionals are responding to these changes.

We held a series of patient and public involvement (PPI) events with women, communities, health professionals, teachers and researchers living and working in England. We wanted to listen and understand more about these issues and what affected communities believe are the healthcare needs and research priorities.

Female genital mutilation (FGM) refers to a set of practices that involve partial or total removal of the external female genitalia for non-therapeutic reasons [ 1 ]. FGM also encompasses practices that involve injury or alteration to the external genitals including gishiri cuts [ 2 ], labial stretching and scarification. The procedure has no known health benefits and often puts those affected at immediate and long-term risk of numerous health problems [ 3 ]. Immediate physical risks include haemorrhage, pain, shock, infection, urination problems and death [ 3 ]. Many affected women go on to endure the consequences for life; they are more likely to have adverse obstetric outcomes [ 4 ] and suffer from mental health problems such as depression and PTSD [ 5 ].

Over 200 million girls and women worldwide are living with the effects of FGM [ 6 ]. Every year, 3 million girls and women are at risk of FGM and exposed to its potentially negative health consequences. Globally FGM is concentrated in a band of sub-Saharan African countries from the Atlantic Coast to the Horn of Africa but women in other countries such as Indonesia are also affected [ 7 ].

There is increasing awareness of FGM as an important health issue in the UK. In 2011, an estimated 103,000 women aged 15–49 with FGM were living in England and Wales [ 8 ]. The prevalence rate (England and Wales) is estimated to be 4.8 per 1000 population. Whilst there are wide variations - London has the highest, but Manchester, Slough, Bristol, Leicester and Birmingham also have high rates - there are likely to be affected women and girls living in every local authority area [ 8 ].

There has been limited research on FGM in England. Africans Unite Against Child Abuse (AFRUCA) explored attitudes towards and experiences of FGM by African communities in Greater Manchester (2015) [ 9 ]. They reported a ‘gaping hole’ in terms of education and the provision of support for FGM-affected communities and emphasised the need to involve men in all efforts to end FGM. They described a ‘culture of silence’ where community members would not admit to knowing anyone who would perform FGM, yet ‘everyone knew where to go if they needed a “cutter”’. They found considerable ambivalence about the UK law. Many felt FGM should not be a criminal offence because it is ‘part of their culture’ [ 9 ]. These issues of legality may be further compounding the cultural taboo that surrounds discussing and researching FGM. A respondent to the Bristol PEER study into women’s experiences and attitudes to FGM (2010) said ‘traditionally it is very difficult in our country to talk about the affairs of FGM, and it is very shameful to speak on it’ [ 10 ]. This shame can influence perceptions of the accessibility of healthcare. The Bristol study concluded that confidence and trust in the health services was minimal. The 2016 PEER study, conducted by FORWARD and Barnardos, captured the views of migrants in Essex and Norfolk and reported that women found it “too hard to open up to their GP” [ 11 ].

In addition to difficulty in speaking up, research has hitherto shown communities perceive a lack of awareness of FGM amongst health professionals as well as lack of appropriate clinical services as key areas to be addressed (Bristol PEER) [ 10 ]. There have been significant efforts to improve services for FGM-affected women and girls in the UK. For example, including the development of e-learning resources and guidance for health professionals [ 12 , 13 ]. These are in the context of government efforts to eliminate the practice. At the 2014 Girl Summit, the then UK Prime Minister David Cameron declared a commitment to eliminating FGM, and announced new funding and actions to tackle FGM including guidance for the police, an NHS FGM prevention programme and changes to legislation [ 14 ].

FGM has been a specific crime in the UK since the 1985 Prohibition of Female Circumcision Act. This was superseded by the 2003 FGM Act, the scope of which was extended by the Serious Crime Act in 2015 [ 15 ]. These amendments add the offence of failure to protect a girl or woman from FGM, provide lifelong anonymity for victims of FGM, and extend the scope of the law extra-territorially. To date, there have been no successful prosecutions for performing FGM in the UK [ 16 ]. The 2015 Act also introduced a mandatory reporting duty requiring all regulated health and social care practitioners and teachers in England and Wales to report cases of FGM where there is a first hand disclosure of FGM or FGM is found on examination [ 17 ]. There is no available data about the number of cases of FGM reported under this mandatory reporting duty and concerns have been raised about the “failure to evaluate introduction of female genital mutilation mandatory reporting” [ 16 ]. We have concerns that the majority of cases of FGM identified through mandatory reporting are historical, and there has been no evaluation on the potential unintended consequences of the mandatory reporting duty on how able women and girls feel to seek help or support for their FGM, both in health and school settings.

Additionally, the UK Health and Social Care Information Centre (HSCIC) (now NHS Digital) have introduced an FGM Enhanced Dataset, making it mandatory for all acute trusts (from July 2015) and GP practices and mental health trusts (from October 2015) in England to submit quarterly data returns detailing FGM-related health data, including patient identifiable information, to the NHS digital enhanced dataset which “supports the Department of Health's NHS Prevention Programme by presenting a national picture of the prevalence of FGM in England” [ 18 ]. The HSCIC have published assurances that no individually identifiable data will be published or shared [ 19 ]. However, there remains in the specification of this dataset a clause which indicates that data would not be shared unless a “legal or statutory gateway” is created [ 20 ]. Future proofing security of such confidential information is a legitimate concern. A recent memorandum of understanding between the Home Office and NHS Digital to enable sharing of confidential information gathered from the NHS to locate and deport undocumented migrants using health services caused concern  [ 21 , 22 ], although the government have announced that this memorandum will be revised and will no longer be used to seek information about individuals for immigration offences alone [ 23 ]. Health professionals remain anxious that however well-intentioned legislation may seem, trust between caregivers and patients will be at risk of irrevocable damage [ 24 , 25 , 26 ]. The rate of data submission has been low, notably from primary care. The 2016–2017 annual report shows that only 74 GP practices (out of a total of approximately 7,613 GP practices in England [ 27 ]) submitted data returns [ 28 ].

In the aftermath of these legislative changes, it is not known what affected communities know and understand about these laws; what their impact is on perceptions of acceptability or uptake of services; whether mandatory reporting could deter young people from speaking up and seeking help, knowing they and their family will be reported to the police; and how these requirements are understood and perceived by professionals, including any impact on their behaviour.

FGM is a harmful practice. Victims need access to services that meet all of their health needs, in all health settings, across the lifecourse. They need to feel able and willing to access those services. Evidence shows these communities are likely to be less able to access health services [ 29 ] despite considerable health needs. It is therefore important to explore the impact of recent FGM legislative changes on relationships with health professionals in the context of their wider health. Through the patient and public events we report here, we sought to work with communities and professionals to explore research priorities and understand research and service needs to support both communities and health professionals working with those affected by FGM in the context of these changes.

Our aim was to gather voices from English communities affected by FGM and voices from professionals (in healthcare and education) serving those communities. We wanted to listen to what they identify as important research and resource needs and to form a platform from which to co-design research that would be acceptable to participants and useful to people affected by FGM as well as policy makers.

The principle that health and care should be designed to be more person-centred, and that individuals have a right to make decisions about treatments and manage their own health, is now firmly established as policy in many health systems [ 30 , 31 , 32 ]. Patient involvement in decisions and organisations has also long been advocated and is actively supported by the National Institute of Health Research in the United Kingdom. This was an exploratory patient and public involvement project (PPI) for which we held a series of focus groups and a seminar [ 33 , 34 ] that we hope will provide a platform for developing participatory research going forward.

Focus groups were held with women from communities affected by FGM in a large urban centre and smaller multi-cultural city, including an innovative PPI workshop using dramatherapy techniques, and with professionals working with these communities from healthcare and education. The project concluded with an interactive seminar involving representatives from social care, health education, advocacy groups, grassroots organisations and community members.

The focus groups were held in two urban settings. In one centre we held four focus group sessions. We chose focus groups as a methodology because, as a form of group discussion, they are an effective way of exploring people’s views, and explore how and why people think as they do about particular issues [ 35 ].

FGM survivors, campaigners and advocates ( n  = 11) led by SD. This group included members of a local rights based organisation committed to preventing FGM, including FGM campaigners, and women from Somali, Sudanese, Nigerian, and Gambian communities, including FGM survivors and anti-FGM activists.

Health professionals ( n  = 8) including representatives from sexual health, obstetrics and gynaecology, general practice, psychology, and health visitors, led by SD and LH.

Teachers ( n  = 4), representing primary and secondary school, led by SD, with one safeguarding lead at a school with high prevalence, and primary school teachers serving relatively high and low prevalence communities

In a large urban centre, we held a PPI discussion led by LH and SP with 6 women from Somalia, who earlier in the day had been taking part in a dramatherapy workshop about experiences of FGM

We asked our focus group participants:

what aspects of FGM they thought we should research and what questions they thought needed to be asked, or answered,

what would be a useful resource, and how to ensure that resources were useful, believable, relevant and acceptable,

what the future needs were for communities affected by FGM and the professionals working with them,

what barriers and facilitators there were to achieve these aims.

Finally, we held a one-day seminar, as part of the Sheila Kitzinger Programme at Green Templeton College in Oxford, in February 2016. We invited experts from across disciplines, including advocacy groups and survivors working in and around FGM. Participants included members of community groups, (including the Oxford Rose community (an Oxford survivors network), BK Luwo (United women’s organisation based in Oxford) and Midaye Somali Development Network (A grassroots Somali charity based in London), people working in clinical services (including obstetrics and gynaecology, midwifery, health visitors, paediatrics and safeguarding, primary care, psychiatry and sexual health), multi-agency team workers (including police, social services and community outreach workers), legal and ethics experts, members of charitable organisations leading the way in developing understanding of FGM and in providing services and support for women, families and communities (including FORWARD, AFRUCA, Oxford Against Cutting, Shifting Sands, 28 Too Many), academics and researchers working in FGM (from disciplines including creative writing, public health, anthropology, the Refugee Studies Centre Oxford and three recipients of Mary Seacole awards working on FGM related projects). During this meeting, we reflected upon the progress made in working to support communities affected by FGM and eliminate the practice, and so asked all participants to consider and discuss what research and service uncertainties and priorities could include to continue to support progress towards this aim [ 36 ].

This article has been written in collaboration with the voices who contributed to our PPI activities. It reflects what we heard during the PPI events, and has been written together with community members, campaigners, and professionals working with FGM affected communities.

The outputs of the focus groups and seminar were collated and summarised thematically [ 37 ].

We were overwhelmed by the passion and energy that participants brought to these PPI events. The willingness to speak out with courage and commitment was noteworthy.

Many felt their culture was stigmatised by the association with FGM, and expressed a wish for a more balanced representation of their cultures and communities, including the positive values and traditions associated with the transition to womanhood. FGM is but one part of women’s lifecourse, and only one thing of many that had happened to them. Women told us that they did not want to feel defined by their FGM, nor be denied the opportunity to consider other health and social issues which may be more important to them.

What should be researched?

Understanding differences.

Different generations within diasporan communities may have different health and educational needs with regard to FGM. More understanding of these differences is vital. This included understanding women’s needs related to FGM at different life stages, but also that the needs of those born in the UK may differ from those who had travelled to live in the UK after birth. There is a need to understand diversity both within and between communities and the different information and support needs they may have.

How much, where and when?

The need to know more about how much/whether/where/how and why FGM was being performed in the UK now, or by UK residents, was identified as an important knowledge gap that could help inform both service design, preventative work and resource development.

Cultural authenticity

Women and professionals discussed that FGM affects a wide range of different communities, with different traditions, FGM practices, and potentially different on-going health consequences. Learning from other groups’ traditions and experiences was identified as necessary and useful, but how and whether resources and stories can or should be shared between cultures was identified as an uncertainty. Having information and resources relevant to all cultures and covering all types of FGM was felt to be a priority, but whether each community needed a personalised resource, or whether unified resources shared across communities was felt to be unknown.

Legal changes

The potential impact of the UK legislation, specifically the 2015 changes including mandatory reporting, the FGM enhanced dataset, and the introduction of the offence of failure to protect a child from FGM, was a key area identified that was felt to warrant further exploration. We heard that it would be important to understand what community members know and understand about the legislation. Questions were raised about what community consultation is for, what makes it adequate and how it is fed back to communities, including understanding how community voices were used in policy development. Whether the laws would alter community or community members’ behaviour, their perception of the accessibility of health services, or influence how professionals interacted with families from affected communities was identified as an important area for further research.

What services do women want?

Women asked us to consider their health needs throughout their life course, stretching from puberty, to their needs before and during marriage, pregnancy and childbirth, and through to the menopause. They noted that antenatal care is an important time to engage with women about FGM, but that they wanted services that looked after women both through the antenatal period and beyond. They asked for services to not be solely focussed on sexual and reproductive health.

While the term “mental health” was identified as potentially difficult by some community members, describing a perception of stigma against mental illness, (we were told that in many cultures the word “mental” is heavily aligned with “being mad” in common parlance), participants requested holistic service provision, in which both physical and emotional or psychological needs were able to be met. The impact of FGM on both women’s and men’s psycho-sexual function was raised as important to learn more about, including how to support couples affected by FGM. The need for safe spaces to discuss FGM, in the context of known difficulties, and pre-existing cultural taboo’s around discussing FGM was raised, and there was considerable reflection on what these might look like.

The appropriate setting for FGM support services was discussed as something that needed exploring, including whether health was the right location for this, and if so whether hospital or community settings would be more acceptable. Many participants questioned whether health settings were the best or only place to discuss FGM. In particular, some uncertainty was raised in one group about whether GPs are the right people to be asking about FGM.

The need for professionals to be aware of FGM, including having skills to respond appropriately to women with FGM without seeming to be horrified or judgemental, was identified as important, with women describing their distress at reactions they or their friends had experienced in healthcare encounters.

What future needs were identified?

The best way of educating professionals was discussed, including learning how to incorporate community voices and experience into the education offered to professionals. Learning how to continue to break down barriers to talking about FGM, for community members and professionals was identified as important. The involvement of affected communities in designing services and facilitating acceptability and usage of services was a recurrent theme, and the role of community facilitators, or health advocates, both to support community members when accessing services, but also in training and educating professionals and developing services was felt to be important to learn more about, and consider implementing. The need to learn more about how legislation may be altering the types of FGM being practiced now, and how much FGM was occurring, when and where, was important.

What are the barriers

Legislation.

The potential impact of the new legislation, on whether services could still be considered as safe and confidential, or acceptable to community members, was a dominant theme in all of our focus groups. The potential impact of the requirement to record and to report FGM to authorities without the consent of the community member on trust was consistently voiced as a major concern throughout this work, by community members (activists, advocates and community members) and by professionals (across health, education, and social care). Specific concerns were also raised by both community members and health professionals about a perceived double standard in the law, specifically, the FGM Act 2003- in particular that FGM is illegal yet there is a permissive societal attitude towards female cosmetic genital surgery which also comprises a range of genital-altering procedures for non-medical reasons.

Some expressed their views that the legislation against FGM was stigmatising and some participants described feeling that it was discriminatory against them and their culture. The community members we spoke to were united in their understanding that FGM is a form of child abuse, and in their commitment to supporting communities and families to protect their children from FGM (safeguarding). Some women observed however, that the safeguarding procedures for FGM were significantly different from the regulations for other forms of child abuse, and that they perceived this as discriminatory and disproportionate.

Cross cultural learning?

Much of the UK research into FGM has been undertaken within single community groups. One of our focus groups, and the multi-agency meeting included participants from a number of community groups (including women and men from Nigeria, Gambia, Ghana, Sudan, and Somalia). There was uncertainty about how transferable the experiences and needs of one community group may be to other communities, who may have different traditions and needs. How and whether to share experiences between communities, and how to create resources was raised. Many felt that learning from different communities’ experiences was informative and enriching, but for health education and resources, there was uncertainty about how this process could be used. There are repeated calls for resources to be community based, but a lack of clear understanding about what this entails, and how we can know if it has been achieved.

Whose voices?

The contribution of anti-FGM activists was acknowledged and hugely valued, but we were asked how to challenge the assumption that they speak for whole communities, and to create opportunities from which to hear and add previously unheard voices to the debate around FGM. How to involve men in the campaign against FGM, and also to understand their views and needs regarding FGM was identified as a research priority. We were asked whether anyone had researched the beliefs and needs of the cutters themselves, noting that they may depend on FGM for financial and status reasons, and therefore we should learn more about how to involve them in aspiring to eliminate the practice of FGM. The question of whether “any” FGM, or type of FGM was acceptable was raised.

As far as we are aware, this is the first published patient and public involvement project asking communities affected by FGM, and professionals involved in providing care for these communities, what they identify as research and service priorities. Previous research in England has gathered information about participants lived reality, experience and attitudes and has provided valuable knowledge about participants' experiences of services, and views about service needs and issues including the UK legislation [ 10 , 11 ]. This study was a patient and public involvement project, in which we sought explicitly to gather community and professional views as part of an exercise in determining research and service priorities. Sharing experiences was not expected or asked for as part of the sessions undertaken. We referred to the INVOLVE principles of developing and designing research [ 38 ] with the public and people the research will be relevant to, and to the James Lind principle of patients and clinicians collaborating in setting priorities [ 39 ].

We were overwhelmed by all that we heard, and the number and breadth of questions we were asked. Participants had a great deal to say about FGM and there were forthcoming with their knowledge and ideas for the future.

Our contributors highlighted the complexity and diversity of experiences and attitudes towards FGM across the UK. We have been challenged to think more pluralistically about: where, when and how to address FGM during a woman’s lifecourse; where and when services should be addressing FGM; what communities to listen to; and how to listen to them.

This PPI project took place in the aftermath of the introduction of legislative changes around FGM and they were being frequently reported in the UK media; [ 40 , 41 ]) which may have influenced the topics identified as important. However, we believe there is a significant need to take forwards in research the questions that were raised during this project, for example to consider what impact the legislative changes has had on behaviour and attitudes of community and professionals, and how to understand how to hear and use community voices when developing legislation and policy that affects them.

Strengths and limitations

This was an initial exploratory project, and was carried out in only two cities in England. Nonetheless, the enthusiasm for engagement in determining research priorities was striking, which we believe demonstrates the feasibility of involving community members in future research. However our work also provides insights into the complexities of work in this area, and the challenges of undertaking research that engages with FGM practices across many different nationalities and the socio-cultural specificity of experiences and priorities in FGM services. Previous studies have focused on communities in isolation from each other [ 10 , 11 ]. We had experience of one focus group made up of women from one community, and another where the focus group included women from different community backgrounds, as did the multi-agency workshop. While the numbers here are too small to draw conclusions, we reflected about whether and how different communities could or should learn from each others’ experiences, what may be lost from mixing groups and what might be gained by sharing between communities.

In planning future work we are clear that research should be co-produced with the communities that it seeks to understand and serve. These workshops revealed the importance of socio-culturally authentic research in this highly contested area. While it doesn’t provide a roadmap to co-design, it does demonstrate that communities are willing to engage with collaborative approaches to priority setting and research development.

There was an overarching desire for solutions, resources and change to develop from communities upwards to professionals and authorities. Any learning and resources need to be co-created and constructed in such a way that they can be effectively shared between women, communities, and professionals. This would allow understandings of what will create effective change, services and training. We need to understand how we can develop and support this process happening, and what techniques, resources and research would be needed to allow this. We need to learn this from the communities themselves.

Abbreviations

Female genital mutilation

• Patient and public involvement

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Acknowledgements

During the writing of the paper LL worked in the Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, and was supported by the NIHR Oxford Biomedical Research Centre. LH is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, grant BRC-1215-20008 to the Oxford University Hospitals NHS Foundation Trust and the University of Oxford. During the writing of this paper SD was supported by an NIHR in practice fellowship within the Nuffield Department of Primary care Health Sciences, University of Oxford.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

This project was supported by a small academic initiatives grant from Green Templeton College, University of Oxford, recipient Louise Locock, and with funding for the final workshop from the Sheila Kitzinger Programme, administered via Green Templeton College, University of Oxford, led by Sharon Dixon and Lisa Hinton.

Availability of data and materials

The report published following these events is available at: http://www.gtc.ox.ac.uk/research-centres/sheila-kitzinger-programme/sheila-kitzinger-programme-events.html , http://www.gtc.ox.ac.uk/images/Report_from_the_Sheila_Kitzinger_seminar.pdf

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Authors and affiliations.

Nuffield department of Primary Care Health Sciences, University of Oxford, Oxford, UK

S. Dixon, L. Locock & L. Hinton

Health Services Research Unit, University of Aberdeen, Aberdeen, UK

Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK

Oxford Against Cutting, Oxford, UK

K. Agha & L. El-Hindi

Midaye Somali Development Network, London, UK

FORWARD, London, UK

N. Otoo-Oyortey

English Creative Writing Department, Brunel University, London, UK

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Contributions

SD and LH facilitated and summarised the discussions from the PPI focus groups, and from the multi-agency seminar. All authors (other than LE) were participants at the multi-agency seminar and contributed to the outputs generated by this meeting. All of the participants from the Sheila Kitzinger meeting were emailed the report and invited to amend, add to and contribute to the report before it was published, and all amendments and comments were incorporated into the project report. All authors contributed to reviewing, shaping, and writing this article, summarising our work together. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to S. Dixon or L. Hinton .

Ethics declarations

Ethics approval and consent to participate.

This was a patient and public involvement project, gathering views from people with an interest in FGM to inform priority setting in research and co-design a research agenda. Our university institutional ethics guidance states that people who are “giving their views on research….do not count as “human participants” in the sense intended by CUREC’s [Central University Research Ethics Committee] policy. They are not giving you information about themselves, and the opinions they offer are not themselves the subject of research. You need not get ethical approval of your research if your contact with people is confined to this sort of interaction”.

https://researchsupport.admin.ox.ac.uk/governance/ethics/faqs-glossary/faqs#collapse410611 (FAQ A6).

All participants freely chose to participate in these events to contribute to the development of a research agenda in this area.

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Not applicable

Competing interests

Sharon Dixon is a trustee of Oxford Against Cutting, Brenda Kelly is a patron of Oxford Against Cutting.

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Dixon, S., Agha, K., Ali, F. et al. Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda. Res Involv Engagem 4 , 29 (2018). https://doi.org/10.1186/s40900-018-0103-5

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Received : 09 December 2017

Accepted : 26 June 2018

Published : 17 September 2018

DOI : https://doi.org/10.1186/s40900-018-0103-5

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