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First Biennial International Nursing and Midwifery Conference
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Midwifery
intrapartum and post partum) continues to hold the perinatal transfer rate in the US at 8%. This costly approach to therapy is not available to women in all countries. Studies underway will evaluate whether more limited courses of therapy administered to women near or at delivery will also reduce mother to child transmission. Transmission of HIV through breast milk continues to be evident, but in developing countries with poor water supplies the benefits of breast feeding still outweigh artificial feeding. The European Collaborative Study of HIV Infection and Pregnant Women found a 19% perinatal transmission rate from 1990-1995. These data represent 21 centres in 7 European countries. CD4 lymphocyte cell counts remain stable during pregnancy. Women whose CD4 count is less than 200 tend to deliver earlier. Premature babies are at higher risk for HIV transmission.
Factors enhancing perinatal transmission Research has described the following factors which enhance perinatal transmission: high maternal viral load, low maternal CD4 count, twin gestation, rupture of membranes longer than four hours and invasive intrapartum procedures with the resultant recommendations to limit vaginal examination, avoid amniotomy and the use of fetal scalp electrodes. A major goal is to limit the exposure of the baby to maternal body fluids. Early baby bathing should be considered. Overall, data continue to be inconclusive regarding the transmission risk due to the mode of delivery, caesarean section versus vaginal birth.
Summary Heterosexual transmission continues to be the most common route for HIV acquisition in women. Until female controlled prevention methods are comfortable, economical and available, women will continue to be at risk from HIV. Perinatal clinical trials utilising multiple therapies are presently underway and hopefully will further reduce transmission. Comprehensive prenatal care and conservative obstetric management will enhance the HIV care of the mother and reduce prematurity and infection sources to the baby. Major new therapy advances continue. While much progress has been made, efforts to improve treatment and prevention of HIV in women and babies must be continued particularly in developing countries where over 90% of HIV infections occur.
Selected conference papers/articles Biggar R Jet al Perinatal intervention trials in Africa: effect of a birth canal cleansing intervention to prevent HIV infection. Lancet 347:1647-1650
Carpenter C Jet al Antiretroviral therapy for HIV infection: recommendations of an international panel. Journal of the American Medical Association 276:146-154 Cohen M H et al Menstrual abnormalities in women with HIV infection. WIHS Collaborative Study Group, USA Gilsin L Cost-effectiveness of improved STD treatment services as a preventative intervention against HIV in Mwanza, Tanzania. London School of Hygiene, UK Gary R H et al Reduced fertility among HIVinfected women: results of cross-sectional and prospective studies in rural Uganda. Johns Hopkins University, Baltimore, Maryland, USA and Makerere University, Kampala, Uganda International AIDS Society, USA. Improving the management of HIV Disease. IAS Journal 4 Newell M Pregnant HIV infected women in Europe: The European Collaborative Study. Institute of Child Health, London, UK UNAIDS The status and trends of the global HIV/AIDS pandemic: Final Report, July 1996. The Joint United Nations Programme on HIV/AIDS UNAIDS Recommendations for the development of vaginal microbicides: the international working group on vaginal microbicides. UNAIDS 10:1-6 Wasserheit J Heterogeneity of heterosexual transmission: the rote of others STDs. The Centers for Disease Control, Atlanta, Georgia, USA
FIRST B I E N N I A L INTERNATIONAL NURSING AND MIDWIFERY CONFERENCE The First Biennial International Nursing and Midwifery Conference, an anabitions venture by the Lothian College of Health Studies, proved highly successful. Many midwives were among the 200 delegates from 15 countries in all five continents who met in Edinburgh, Scotland, to explore 'Professional Roles in Practice'. The midwifery scene was set early in the conference by Patricia Purton, Royal College of Midwives, Edinburgh, who gave an 'Introduction to research-based practice' and subsequently Beatrice Grant, Professional Officer (Midwifery), National Board for Nursing, Midwifery and Health Visiting for Scodand, focused on 'Ensuring quality in education for practice'. 'Modernising Midwifery for the New Millenium', an aspiring keynote address by Professor Lesley Page, Thames Valley University, UK, was warmly received by nurses as well as midwives, perhaps because so many were also mothers. As might be expected, most of the midwifery concurrent sessions focused on clinical practice. Francesca Pankhurst from the University of Brighton, UK, described an evaluation of a pilot scheme to introduce case-load midwifery, and Monica
Thompson, a professional development adviser at the Simpson Memorial Maternity Pavilion, Edinburgh, Scotland, addressed moves towards midwifery formulary and prescribing. 'The effects of maternal semiFowler's position with lateral tilt on antepartum cardiotocograms' were discussed by Faith Wright, a lecturer from Dalhousie University, Halifax, Nova Scotia, Canada. The maternal viewpoint was not neglected. Sandra Smith, a labour ward midwife from Livingstone, Scotland, spoke of the effects of childhood sexual abuse on pregnancy, birthing and motherhood. Angela McLoughlin, a lecturer in nursing at the University of Manchester, England, explored parental perceptions of information received from nurses and doctors in neonatal units, and Edna McKim from the Memorial University of Newfoundland, Canada, considered 'The transition to home for mothers of healthy and initially ill newborn babies'. Two presentations offered opportunity for comparison: the effects of female support in labour, as observed by Cecilia Banyana Madi, a midwife from the University of Surrey, Guildford, England, and some findings of a doctoral study by Marita Pannonen, a professor in nursing sciences at the University of Tampere, Finland, on 'Social support and its impact on mothers' experiences of childbirth'. Attendants' views were put forward by Vanora Hundley, a research midwife from the Dugald Baird Centre for Research on Womens' Health, Aberdeen, Scotland, in her talk, 'Midwives' satisfaction: how important is delivery setting?' (a full report of this study has been published in this Journal, Hundley et al 1995). Teaching interests were specifically addressed in a poster presentation by the Lothian College of Health Studies: 'Perceptions and methods of teaching midwifery practice'. The Lothian College is shortly to become the Faculty of Health Studies at Napier University, Edinburgh, and as such wilt organise and host the Second Biennial International Nursing and Midwifery Conference in September 1998. The theme will be 'Chances, Changes and Choices: A View Towards 2000'. Further information about the conference can be obtained from Carol Edgar, Course and Conference Organiser, Faculty of Health Studies, Napier University, 74 Canaan Lane, Edinburgh EHI0 4TB, Scotland, UK. Tel: 0131 536 5627 Fax: 0131 536 5681.
Molly Lobban REFERENCES Hundley V, Cmikshank F M, Milne Jet a11995 Satisfaction and continuity of care: staff views of care in a midwife-managed delivery unit. Midwifery 11: 163-173
Midwifery
intrapartum and post partum) continues to hold the perinatal transfer rate in the US at 8%. This costly approach to therapy is not available to women in all countries. Studies underway will evaluate whether more limited courses of therapy administered to women near or at delivery will also reduce mother to child transmission. Transmission of HIV through breast milk continues to be evident, but in developing countries with poor water supplies the benefits of breast feeding still outweigh artificial feeding. The European Collaborative Study of HIV Infection and Pregnant Women found a 19% perinatal transmission rate from 1990-1995. These data represent 21 centres in 7 European countries. CD4 lymphocyte cell counts remain stable during pregnancy. Women whose CD4 count is less than 200 tend to deliver earlier. Premature babies are at higher risk for HIV transmission.
Factors enhancing perinatal transmission Research has described the following factors which enhance perinatal transmission: high maternal viral load, low maternal CD4 count, twin gestation, rupture of membranes longer than four hours and invasive intrapartum procedures with the resultant recommendations to limit vaginal examination, avoid amniotomy and the use of fetal scalp electrodes. A major goal is to limit the exposure of the baby to maternal body fluids. Early baby bathing should be considered. Overall, data continue to be inconclusive regarding the transmission risk due to the mode of delivery, caesarean section versus vaginal birth.
Summary Heterosexual transmission continues to be the most common route for HIV acquisition in women. Until female controlled prevention methods are comfortable, economical and available, women will continue to be at risk from HIV. Perinatal clinical trials utilising multiple therapies are presently underway and hopefully will further reduce transmission. Comprehensive prenatal care and conservative obstetric management will enhance the HIV care of the mother and reduce prematurity and infection sources to the baby. Major new therapy advances continue. While much progress has been made, efforts to improve treatment and prevention of HIV in women and babies must be continued particularly in developing countries where over 90% of HIV infections occur.
Selected conference papers/articles Biggar R Jet al Perinatal intervention trials in Africa: effect of a birth canal cleansing intervention to prevent HIV infection. Lancet 347:1647-1650
Carpenter C Jet al Antiretroviral therapy for HIV infection: recommendations of an international panel. Journal of the American Medical Association 276:146-154 Cohen M H et al Menstrual abnormalities in women with HIV infection. WIHS Collaborative Study Group, USA Gilsin L Cost-effectiveness of improved STD treatment services as a preventative intervention against HIV in Mwanza, Tanzania. London School of Hygiene, UK Gary R H et al Reduced fertility among HIVinfected women: results of cross-sectional and prospective studies in rural Uganda. Johns Hopkins University, Baltimore, Maryland, USA and Makerere University, Kampala, Uganda International AIDS Society, USA. Improving the management of HIV Disease. IAS Journal 4 Newell M Pregnant HIV infected women in Europe: The European Collaborative Study. Institute of Child Health, London, UK UNAIDS The status and trends of the global HIV/AIDS pandemic: Final Report, July 1996. The Joint United Nations Programme on HIV/AIDS UNAIDS Recommendations for the development of vaginal microbicides: the international working group on vaginal microbicides. UNAIDS 10:1-6 Wasserheit J Heterogeneity of heterosexual transmission: the rote of others STDs. The Centers for Disease Control, Atlanta, Georgia, USA
FIRST B I E N N I A L INTERNATIONAL NURSING AND MIDWIFERY CONFERENCE The First Biennial International Nursing and Midwifery Conference, an anabitions venture by the Lothian College of Health Studies, proved highly successful. Many midwives were among the 200 delegates from 15 countries in all five continents who met in Edinburgh, Scotland, to explore 'Professional Roles in Practice'. The midwifery scene was set early in the conference by Patricia Purton, Royal College of Midwives, Edinburgh, who gave an 'Introduction to research-based practice' and subsequently Beatrice Grant, Professional Officer (Midwifery), National Board for Nursing, Midwifery and Health Visiting for Scodand, focused on 'Ensuring quality in education for practice'. 'Modernising Midwifery for the New Millenium', an aspiring keynote address by Professor Lesley Page, Thames Valley University, UK, was warmly received by nurses as well as midwives, perhaps because so many were also mothers. As might be expected, most of the midwifery concurrent sessions focused on clinical practice. Francesca Pankhurst from the University of Brighton, UK, described an evaluation of a pilot scheme to introduce case-load midwifery, and Monica
Thompson, a professional development adviser at the Simpson Memorial Maternity Pavilion, Edinburgh, Scotland, addressed moves towards midwifery formulary and prescribing. 'The effects of maternal semiFowler's position with lateral tilt on antepartum cardiotocograms' were discussed by Faith Wright, a lecturer from Dalhousie University, Halifax, Nova Scotia, Canada. The maternal viewpoint was not neglected. Sandra Smith, a labour ward midwife from Livingstone, Scotland, spoke of the effects of childhood sexual abuse on pregnancy, birthing and motherhood. Angela McLoughlin, a lecturer in nursing at the University of Manchester, England, explored parental perceptions of information received from nurses and doctors in neonatal units, and Edna McKim from the Memorial University of Newfoundland, Canada, considered 'The transition to home for mothers of healthy and initially ill newborn babies'. Two presentations offered opportunity for comparison: the effects of female support in labour, as observed by Cecilia Banyana Madi, a midwife from the University of Surrey, Guildford, England, and some findings of a doctoral study by Marita Pannonen, a professor in nursing sciences at the University of Tampere, Finland, on 'Social support and its impact on mothers' experiences of childbirth'. Attendants' views were put forward by Vanora Hundley, a research midwife from the Dugald Baird Centre for Research on Womens' Health, Aberdeen, Scotland, in her talk, 'Midwives' satisfaction: how important is delivery setting?' (a full report of this study has been published in this Journal, Hundley et al 1995). Teaching interests were specifically addressed in a poster presentation by the Lothian College of Health Studies: 'Perceptions and methods of teaching midwifery practice'. The Lothian College is shortly to become the Faculty of Health Studies at Napier University, Edinburgh, and as such wilt organise and host the Second Biennial International Nursing and Midwifery Conference in September 1998. The theme will be 'Chances, Changes and Choices: A View Towards 2000'. Further information about the conference can be obtained from Carol Edgar, Course and Conference Organiser, Faculty of Health Studies, Napier University, 74 Canaan Lane, Edinburgh EHI0 4TB, Scotland, UK. Tel: 0131 536 5627 Fax: 0131 536 5681.
Molly Lobban REFERENCES Hundley V, Cmikshank F M, Milne Jet a11995 Satisfaction and continuity of care: staff views of care in a midwife-managed delivery unit. Midwifery 11: 163-173