The impact of litigation on midwives.

Litigation is rising in maternity care and there is no evidence that it will slow down. Advertisements with a 'no win no fee' message encourage people to seek out lawyers. It is true that we are becoming an increasingly litigious society and claims in maternity care often lead to very high pay-outs. This can be millions of pounds for child with cerebral palsy if liability is admitted. Legal processes are fascinating but it does not feel like this if you are personally caught up in them.

Traditional birth attendant training and local birthing practices in India.

Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.

Over-the-counter medication use for childhood fever: a cross-sectional study of Australian parents.

AIM: To report Australian parents' medication (paracetamol, ibuprofen and homeopathic) use in childhood fever management. METHODS: A cross-sectional survey of 401 Queensland parents of children aged between 6 months and 5 years recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods was conducted. A 17-item instrument was developed; construct and content validity were determined by an expert panel; and item reliability by test-retest with nine parents. Areas targeted were medication use and influences on and barriers to medication use. RESULTS: Most participants were female, had tertiary education and lived in a major city (mean age 34.6 years). Reducing children's fever with over-the-counter medications was common (91%): 94% of parents reported using paracetamol and 77% reported using ibuprofen. A few (3.7%) used homeopathic remedies. Dosage was determined by weight (86.3%), age (84.3%), temperature (32.4%), illness severity (31.4%) and lethargy (20.9%). Frequency was determined by instructions on the medication label (55.3%), temperature (40.6%) and well-being (27.7%). Ibuprofen was administered too frequently by 31.5% (four hourly by 22.8%), and paracetamol by 3.8%. Fifty-two per cent had alternated medications, 65.8% of these for temperatures below 38.5 degrees C. Decisions to alternate were influenced by information from doctors/hospitals (49.5%) and children remaining febrile post-antipyretic (41.7%). Most parents reported over-the-counter medications as potentially harmful (73.2%), citing liver (38.2%), stomach (26.4%) and kidney (18.6%) damage and overdose (35.7%) as concerns. When medications were refused or spat out (44.0%), parents used force (62.4%), different methods (29.5%) or suppositories (20.8%). CONCLUSIONS: Most parents used over-the-counter medications to reduce fever, often below 38.5 degrees C. The belief that these medications were harmful was overridden by fears of harmful outcomes from fever.