SummaryThe objective of the study is to provide evidence‐based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow‐up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print‐friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high‐quality evidence and warrant further research. These areas are highlighted in the paper.

Background Midwives and nurses appear vulnerable to moral distress when caring for women whose babies are removed at birth. They may experience professional dissatisfaction and their relationships with women, families and colleagues may be compromised. The impact of moral distress may manifest as anger, guilt, frustration, anxiety and a desire to give up their profession. While there has been much attention exploring the concept of moral distress in midwifery, this is the first study to explore its association in this context. Aim This article explores midwives’ experiences of moral distress when providing care to women whose babies were removed at birth and gives valuable insight into an issue nurses and midwives encounter in their profession. Methods Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate data; mothers were interviewed face to face and midwives through focus groups. The images and audio data were collected, transcribed and analysed for emerging themes. For the purpose of this article, only the midwives’ stories are reported. This research received a favourable ethical opinion from the University of Surrey Ethics committee. Ethical considerations This study received a favourable ethical approval from a higher education institutes ethics committee. Results Midwives who care for women whose babies are removed at birth report it as one of the most distressing areas of contemporary clinical practice. Furthermore, they report feelings of guilt, helplessness and betrayal of the midwife–mother relationship. Many of the midwives in this study state that these experiences stay with them for a long time, far more than more joyful aspects of their role. Conclusion Midwives experience moral distress. Support systems, education and training must be available to them if we are to reduce the long-term impact upon them, alleviate their distress and prevent them from leaving the profession.

It is evident from a review of the literature that looking after the psychological and emotional needs of women who have their baby removed at birth is a vital part of midwifery care in the childbirth continuum. This review reports on the experiences of midwives who have provided care and emotional support to mothers who have had their baby removed at birth and the challenges they have encountered from doing so. BNI, CINAHL, EMBASE, Google Scholar, Maternity and Infant Care and PsycInfo were searched for articles published until January 2014 and findings suggest that providing care and emotional support to women who have had their babies removed at birth remains one of the most challenging aspects of contemporary midwifery practice. It is anticipated that this study will raise awareness of the challenges associated with providing care and emotional support for women whose babies have been removed at birth and contribute to the evidence base for best practice.

This article is a personal reflection and exploration of the potential of poetry in palliative care. Poetry can help enable expression of individuals' deepest unspoken concerns and may provide a means of providing spiritual care. The author draws on her personal experience as a community nurse, together with the views of patients and colleagues, and discusses the literature. Some limitations to the use of poetry are considered, as are the skills needed to help patients use poetry. To illustrate the potential therapeutic value of poetry in palliative care, examples of poems by poets, patients and the author are included. The article concludes that poetry can bring about a sense of healing, and should be considered as a possible addition to other holistic therapies.

AimsThe study examined knowledge and attitudes around Sexual Health (SH) and contraceptive use among Young People (YP) who are homelessness and resident in hostels in a large urban area and their key workers. The aim was to improve SH outcomes through building a model of SH care appropriate to the needs of YP. Less is known about SH in homeless young males’ than females’, thus the study aimed to ensure inclusion of male views.MethodsA constructivist theoretical framework was used to underpin this qualitative ethnographic case study. The case under study being homeless YP, girls, boys or transgender, aged 16–21 years resident in homeless hostel accommodation. Participants were selected by purposive sampling in order to ensure maximum variety within the case. Twenty-nine homeless YP, and five key workers were recruited from homeless hostels and a homeless day-centre in a large urban area. One to one semi-structured interviews were carried out examining knowledge and attitudes concerning SH and contraceptive use. Insider observations of resident’s meetings and the hostel and centre settings were undertaken. A reflexive approach was used in interviewing. Demographic data was collected from YP participants. Nvivo 10 QSR computer assisted software was used to analyse the data thematically, and demographic data used to stratify and identify trends between males, females and age groups.ResultsFour overarching themes were identified: Meaning of sexual health:○ Tended to differ between males and females○ Females made associations with emotions, relationships and safety○ Males with using protection○ Life experiences have overriding effect on:○ Attitudes○ Sexual well-being.○ Being homeless poses risks and influences priority of SH:○ Hygiene○ Dangers○ Survival○ Use of SH services:○ Barriers○ Stigma and embarrassment○ Staff attitudesFacilitators Using non SH services e.g. GPs ConclusionHomeless YP resident in hostel accommodation require specialised delivery of SH care which is holistic and supports their needs. This could be provided within the familiar hostel or day-centre environment. It should be managed in a way that ensures facilitation of quality therapeutic relationships, with highly skilled workers, and sensitive dissemination of targeted information.