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Volume 27, Issue 6, December 2011, Pages 817-824
Helen G. Hall | Debra L. Griffiths | Lisa G. McKenna
Background: the use of complementary and alternative medicine (CAM) has become increasingly prevalent in industrialised countries, with women being the most prolific users. Some women continue to consume these therapies when they become pregnant. Aim: to review the literature exploring prevalence and motivation for use of complementary and alternative medicine by pregnant women. Method: a search for relevant literature published from 2001 was undertaken using a range of databases and by examining relevant bibliographies. Results: although the estimates vary widely from 1% to 87%, the general trend indicates that a significant number of pregnant women use complementary and alternative medicine. Common modalities used include massage, vitamin and mineral supplements, herbal medicine, relaxation therapies and aromatherapy. Reasons for use are varied and include the belief that these therapies offer safe alternatives to pharmaceuticals, they allow greater choice and control over the childbearing experiences, and they are congruent with their holistic health beliefs. The influence of traditional cultural practices on the use of these therapies is unclear. Most expectant women rely on advice from family and friends, and many do not disclose their use to their pregnancy care providers. Conclusions: many women use complementary and alternative medicine when they are pregnant. Further research is needed to gain a greater understanding of the true prevalence and expectant women's motivation for the use of complementary and alternative medicine. Health-care professionals are encouraged to ask women about their use of these treatments and seek out relevant information. © 2010 Elsevier Ltd.
Volume 27, Issue 6, December 2011, Pages 793-801
Mary Carolan | Dorota Frankowska
Objective: to examine the evidence in relation to advanced maternal age (35-39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries. Background: this review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35-39 years is sketchy and often contradictory. Methods: a systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35-39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria. Findings: evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35-39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood. Key conclusions and implications for practice: although risk and rates of adverse perinatal outcome are increased among women aged 35-39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association. © 2010 Elsevier Ltd.
Stressful events, social support and coping strategies of primiparous women during the postpartum period: A qualitative study
Volume 27, Issue 2, April 2011, Pages 237-242
C. Razurel | M. Bruchon-Schweitzer | A. Dupanloup | O. Irion | M. Epiney
Objective: to identify problems and events perceived as stressful by primiparous mothers during the postpartum period, and to explore the social support and coping strategies they used to face these situations. Design: a qualitative study. Data were collected via semi-structured interviews and analysed using a content-analysis method. Setting: Geneva University Hospitals, Geneva, Switzerland from October 2006 to March 2007. Participants: 60 women interviewed six weeks after the birth at term of their first child. Findings: during the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Breast feeding was perceived negatively by the new mothers, and this may be due to the difference between the actual problems encountered and the idealised expectations conveyed by prenatal information. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period. Mothers expressed the need to be accompanied and counselled when problems arose and regretted the lack of long-term postpartum support. Key conclusions and implications for practice: both the prenatal education and postpartum social support seem to mismatch women's needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to provide mothers with more adequate postpartum assistance. © 2009 Elsevier Ltd.
A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: A randomised controlled trial
Volume 27, Issue 2, April 2011, Pages 257-264
Tzu ting Huang | Chieh Ying Yeh | Yc Chen Tsai
Objective: to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. Design: a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. Setting: a 3900-bed medical centre in northern Taiwan with around 3000 births annually. Participants: a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. Interventions: the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24-48 hours after birth to six months post partum. Measurements: body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). Findings: average gestational weight gain was 14.02, 15.27 and 16.22. kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08. kg in the three groups, respectively. Key conclusions: a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. Implications for practice: the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle. © 2009 Elsevier Ltd.
Volume 27, Issue 4, August 2011, Pages 437-444
Christine M. Furber | Linda McGowan
Objective: to explore the experiences related to obesity in women with a body mass index (BMI)>35kg/m 2 during the childbearing process. Design: a qualitative design was used. Data were collected using semi-structured interviews and field notes. Women were interviewed in the third trimester of pregnancy and between three and nine weeks after the birth. Transcribed data were analysed using framework analysis methods. Setting: one maternity service in the North of England. Participants: 19 women with BMI>35kg/m 2. Findings: these women highlighted their feelings of humiliation, and the stigma associated with being pregnant, when obese. Interactions with health professionals and the general public reinforced their discomfort about their size. The high-risk status of their pregnancy increased the medicalisation of their pregnancy. The ultrasound scan was a significant source of distress if difficulties imaging the fetus were not clearly explained during the procedure. Key conclusions: pregnant women who are obese are sensitive of their size. The interactions with health professionals and others that they encounter may increase distress. Implications for practice: health professionals should be more aware of the psychological implications of being obese. Communication strategies about care should be clear and honest, and conveyed in a sensitive manner. Written comments related to size on 'hand-held' notes should be explained at the time of writing. © 2010 Elsevier Ltd.
Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women
Volume 27, Issue 6, December 2011, Pages e238-e245
K. I. Mohammad | J. Gamble | D. K. Creedy
Objectives: to investigate the prevalence of depression during pregnancy and postpartum period for Jordanian women and identify associated risk factors and maternity service delivery issues. Design: a prospective cross-sectional study. Participants were recruited during the last trimester of pregnancy, provided personal, social and obstetric information, and completed the Edinburgh Postnatal Depression Scale (EPDS), Depression Anxiety and Stress Scale (DASS-21), the Maternity Social Support Scale (MSSS), the Cambridge Worry Scale (CWS), Perceived Self-Efficacy Scale (PSES) and Perceived Knowledge Scale (PKS). All participants were contacted again at six-eight weeks and six months post partum to complete a telephone or face-to-face interview. The postnatal questionnaire included the EPDS, MSSS, and DASS-21. Setting: a teaching hospital and five health centres in Irbid city in northern Jordan. Participants: Arabic speaking women (n=353) between the ages of 18 and 45 years, in their last trimester of pregnancy, at low risk for obstetric complications and receiving antenatal care between November 2005 and August 2006. Findings: high rates of antenatal (19%) and postnatal depression (22%) were reported. A regression analysis revealed that stress, anxiety, financial problems, perceived lack of parenting knowledge, difficult relationship with the mother-in-law, unplanned pregnancy, and low self-efficacy were associated with antenatal depression. These seven factors accounted for 83% (r 2=0.834) of variance in the development of probable antenatal depression. At six-eight weeks post partum, a regression analysis revealed that antenatal depression, unplanned pregnancy, difficult relationship with mother-in-law, dissatisfaction with overall care, stress, lack of social support, giving birth to a female baby, feeling pressured to birth the baby quickly, and perceived low parenting knowledge were associated with postnatal depression. These nine variables accounted for 82% (r 2=0.819) of variance in the development of probable PND. Three intrapartum and postpartum variables associated with PND at six-eight weeks (postpartum haemorrhage, unhelpful doctors during labour and birth, and anxiety) were no longer associated with PND at six months. Conclusions and implications for practice: Jordanian women need support to prepare for labour and birth. Postpartum emotional support and assessment of symptoms of depression needs to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about antenatal and postnatal depression are necessary. Quality assurance systems would help reduce the rate of invasive obstetric procedures, and give greater emphasis to emotional care provided to women during the perinatal period. © 2010 Elsevier Ltd.
Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors
Volume 27, Issue 5, October 2011, Pages 620-627
Annika Karlström | Astrid Nystedt | Margareta Johansson | Ingegerd Hildingsson
Objective: to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference. Design: mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis. Setting: three hospitals in the county of Västernorrland in the middle of Sweden. Participants: 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy. Findings: a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories. Key conclusions: rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way of giving birth is common during pregnancy. This should be of concern for midwives and obstetricians during antenatal care. Information and counselling should be frequent and comprehensive when a discussion on caesarean section is initiated by the pregnant woman. A negative birth experience is related to a future preference for caesarean section and this should be considered by caregivers providing intrapartum care. © 2010 Elsevier Ltd.
Volume 27, Issue 4, August 2011, Pages 560-567
Helen Haines | Julie F. Pallant | Annika Karlström | Ingegerd Hildingsson
Background: research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool. Methods: a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n=386) and Australia (n=123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale. Findings: close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample. Conclusion: the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section. © 2010 Elsevier Ltd.
'Not waving but drowning': A study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women
Volume 27, Issue 4, August 2011, Pages 424-430
Virginia A. Schmied | Margie Duff | Hannah G. Dahlen | Annie E. Mills | Gregory S. Kolt
Objective: to explore the experiences and concerns of health professionals who care for childbearing women who are obese. Background: obesity is increasing nationally and internationally and has been described as an epidemic. A number of studies have highlighted the risks associated with obesity during childbirth, yet few studies have investigated the experiences and concerns of midwives and other health professionals in providing care to these women. Design: a descriptive qualitative study using focus groups and face-to-face interviews to collect data. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Setting: three maternity units in New South Wales, Australia. Participants: participants included 34 midwives and three other health professionals. Findings: three major themes emerged from the data analysis: 'a creeping normality', 'feeling in the dark' and 'the runaway train'. The findings highlight a number of tensions or contradictions experienced by health professionals when caring for childbearing women who are obese. These include, on the one hand, an increasing acceptance of obesity ('a creeping normality'), and on the other, the continuing stigma associated with obesity; the challenges of how to communicate effectively with pregnant women about their weight and the lack of resources, equipment and facilities ('feeling in the dark') to adequately care for obese childbearing women. Participants expressed concerns about how quickly the obesity epidemic appears to have impacted on maternity services ('the runaway train') and how services to meet the needs of these women are limited or generally not available. Conclusion and implications for practice: it was clear in this study that participants felt that they were 'not waving but drowning'. There was concern over the fact that the issue of obesity had moved faster than the health response to it. There were also concerns about how to communicate with obese women without altering the relationship. Continuity of care, training and skills development for health professionals, and expansion of limited services and facilities for these women are urgently needed. © 2010 Elsevier Ltd.
Volume 27, Issue 6, December 2011, Pages 848-853
Åsa Premberg | Gunilla Carlsson | Anna Lena Hellström | Marie Berg
Objective: to describe fathers' experiences during childbirth. Design: qualitative method with phenomenological lifeworld approach. A re-enactment interview method, with open-ended questions analysed with a phenomenological method, was used. Participants and setting: 10 first-time fathers from two hospitals were interviewed four to six weeks after childbirth in Southwest Sweden during the autumn of 2008. Findings: the essential meaning of first-time fathers' lived experience of childbirth was described as an interwoven process pendulating between euphoria and agony. The four themes constituting the essence was: 'a process into the unknown', 'a mutually shared experience', 'to guard and support the woman' and 'in an exposed position with hidden strong emotions'. Key conclusions: childbirth was experienced as a mutually shared process for the couple. The fathers' high involvement in childbirth, in cooperation with the midwife, and being engaged in support and care for his partner in her suffering is fulfilling for both partners, although the experience of the woman's pain, fear of the unknown and the gendered preconceptions of masculine hegemony can be difficult to bear for the father-to-be. Implications for practice: in order to maintain and strengthen childbirth as a mutually shared experience for the couple, the father needs to be recognised and supported as a parent-to-be. Midwives have to acknowledge fathers as valued participants and support their significant position. © 2010 Elsevier Ltd.
Young mothers who choose to breast feed: The importance of being part of a supportive breast-feeding community
Volume 27, Issue 1, February 2011, Pages 53-59
Amy Brown | Peter Raynor | Michelle Lee
Objective: to examine factors associated with breast-feeding initiation and duration in young mothers (≤24 years). Design: a retrospective questionnaire completed between six and 24 months post partum. Setting: mothers were recruited from local mother and infant groups, nurseries and online mother and infant forums. Participants: 138 mothers aged between 17 and 24 years (mean age 21.93 years). Measurements and findings: participants completed a retrospective questionnaire about their experience of breast or artificial milk feeding during the first six months post partum. A further 10 mothers who breast fed for at least six months completed a semi-structured interview. Breast feeding for at least six months was positively associated with attending a breast-feeding support group, believing breast feeding to be easy, being part of an environment where breast feeding is normative, and being encouraged to breast feed by others. Key conclusions: themes raised highlight the importance of viewing breast feeding as the normal way to feed an infant and having others support the mother in this behaviour. Implications for practice: increasing breast-feeding initiation and duration among this at-risk group is important for both infant and maternal health. Helping mothers to view breast feeding as the norm, creating an environment where breast feeding is accepted, providing professional and peer support, and encouraging the mother to continue breast feeding are important steps in raising breast-feeding rates among younger mothers. © 2009 Elsevier Ltd.
Factors that contribute to midwives staying in midwifery: A study in one area health service in New South Wales, Australia
Volume 27, Issue 3, June 2011, Pages 331-335
Katie Sullivan | Linette Lock | Caroline S E Homer
Objective: the Australian health workforce is experiencing workforce shortages like many other countries. Managing retention is one important element of workforce planning. Determining the drivers of retention in midwifery can assist workforce planning. The objective of this study was to determine the factors that contribute to the retention of midwives, that is, why do midwives stay? Design: a descriptive design was undertaken in two phases. Phase one used focus groups to adapt a questionnaire used in the 'Why Midwives Stay' study in England for the Australian context. Phase two used the questionnaire to collect qualitative and quantitative data. Setting: one area health service in New South Wales, Australia. Participants: 392 midwives employed in the area health service either full-time, part-time or on a casual basis were invited to participate and 209 (53%) responded. Findings: the majority of respondents were women aged 23-69 years (mean age 42 years). Just over half had received their midwifery qualification through the hospital-based system which was usual prior to 1994 reflecting the age of the cohort. The top three reasons for staying in midwifery were 'I enjoy my job', 'I am proud to be a midwife' and 'I get job satisfaction'. Job satisfaction was received when midwives felt that they made a difference to women, had positive interactions with women in their care and saw women happy. The motivation to keep going was achieved through having a positive outlook; having job satisfaction, and, having work colleagues with a sense of belonging. Implications for practice: the findings have implications for the organisation of care, models of care, and management systems. Health services and departments of health need to consider these issues especially in an environment of workforce shortages. Addressing the way care is arranged and how staff are supported may lead to higher retention rates, thus reducing costs. © 2011 Elsevier Ltd.
Volume 27, Issue 5, October 2011, Pages 745-749
Joan Webster | Catherine Nicholas | Catherine Velacott | Noelle Cridland | Lisa Fawcett
Objective: to evaluate the impact of social support on postnatal depression and health-related quality of life. Design: prospective cohort study. Data were collected at baseline and at six weeks post discharge using a postal survey. Setting and participants: between August and December 2008, 320 women from a large tertiary hospital were recruited following the birth of their infant. Measurements: Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale and World Health Organization Quality of Life assessment questionnaire. Findings: of the 320 women recruited, 222 (69.4%) returned their six-week questionnaire. Women with low social support had significantly higher scores on the EPDS than women who reported adequate support (p=0.007). There was also a significant effect of social support on health-related quality of life. Women with low family or partner support scored lower in all domains, with the greatest mean difference in the social health domain (p=0.000). Of those scoring >10 on the EPDS, 75.5% had sought professional help. Conclusions and implications for practice: women with low social support are more likely to report postnatal depression and lower quality of life than well-supported women. Careful assessment of a woman's level of support following the birth, particularly from her partner and family, may provide useful information for possible interventions. © 2010 Elsevier Ltd.
Not-patient and not-visitor: A metasynthesis fathers' encounters with pregnancy, birth and maternity care
Volume 28, Issue 4, August 2012, Pages 362-371
Mary Steen | Soo Downe | Nicola Bamford | Leroy Edozien
Introduction: the active engagement of fathers in maternity care is associated with long-term health and social benefits for the mother, baby and family. The maternity care expectations and experiences of expectant and new fathers have received little attention to date. Aim: to identify and synthesise good quality qualitative research that explores the views and experiences of fathers who have encountered maternity care in high resource settings. Methods: based on a pre-determined search strategy, relevant databases were searched for papers published between January 1999 and January 2010. Backchaining of the reference lists in included papers was undertaken. Inclusion criteria: good quality qualitative research studies exploring fathers' involvement in maternity care through pregnancy, birth, and up to 6 months postnatally, that were undertaken in high resource countries. No language restrictions were imposed. Analytic strategy: the analysis was based on the metaethnographic techniques of Noblit and Hare (1988) as amended by Downe et al. (2007). Findings: from 856 hits 23 papers were included. The emerging themes were as follows: risk and uncertainty, exclusion, fear and frustration, the ideal and the reality, issues of support and experiencing transition. Synthesis: fathers feel themselves to be 'partner and parent' but their experience of maternity care services is as 'not-patient and not-visitor'. This situates them in an interstitial and undefined space (both emotionally and physically) with the consequence that many feel excluded and fearful. Conclusions: fathers cannot support their partner effectively in achieving the ideal of transition to a successful pregnancy, joyful birth and positive parenthood experience unless they are themselves supported, included, and prepared for the reality of risk and uncertainty in pregnancy, labour and parenthood and for their role in this context. © 2011 Elsevier Ltd.
Volume 27, Issue 5, October 2011, Pages 588-594
Heather L. Longworth | Carol K. Kingdon
Objective: to explore the role, expectations and meanings that individual fathers ascribe to their presence at birth. Design: a Heideggerian phenomenological approach utilising in-depth interviews at two different time points. Setting: large tertiary maternity unit in the North West of England. Participants: 11 first-time fathers accessed through hospital-based parentcraft sessions. Findings: four main themes were evident: fathers' disconnection with pregnancy and labour; fathers on the periphery of events during labour; control; and fatherhood beginning at birth and reconnection. Key conclusions: birth is the moment that fathers ascribe as the beginning of fatherhood. However, through their lack of knowledge and perceived control, they struggle to find a role there. Implications for practice: midwives are ideally placed to help fathers to find a role through parentcraft and encouraging participation at birth. © 2010 Elsevier Ltd.
Volume 29, Issue 5, May 2013, Pages 506-518
Emily de Jager | Helen Skouteris | Jaclyn Broadbent | Lisa Amir | Kate Mellor
Background: the World Health Organization recommends that all infants worldwide are exclusively breastfed for the first 6 months of life for optimal health and development. However, very few women worldwide are meeting this recommendation. Psychosocial factors have been identified as potentially modifiable factors implicated in a woman's ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration. Methods: a search of psychological, nursing and medical databases was conducted in June 2011 for studies published from 2000 to 2011 examining psychological correlates of exclusive breastfeeding to four to 6 months duration. Results: nine papers from eight studies were found to be eligible for the review. Psychological factors have been reported to be highly predictive of exclusive breastfeeding outcomes. Research to date shows that psychosocial factors are not only importantly implicated in exclusive breastfeeding duration but they can also be changed through intervention and experiences. Conclusions: while there is a wealth of literature on the role of psychosocial factors in breastfeeding, there is very limited research specifically examining the role of psychosocial factors of exclusive breastfeeding to 6 months duration. Interpreting the results of the available literature is difficult due to the various methodologies and definitions of exclusive breastfeeding and small sample sizes. Further research, specifically, longitudinal cohort studies are needed which examine psychological determinants of exclusive breastfeeding and infant feeding methods from pregnancy through to 6 months postpartum. © 2012 Elsevier Ltd.
Seeing and holding a stillborn baby: Mothers' feelings in relation to how their babies were presented to them after birth-Findings from an online questionnaire
Volume 29, Issue 3, March 2013, Pages 246-250
Kerstin Erlandsson | Jane Warland | Joanne Cacciatore | Ingela Rådestad
Objective: to determine if the way caregivers offer opportunities to see and hold a stillborn baby impacts a mother's feelings about the experience of seeing and holding her newborn. Design and setting: a web questionnaire hosted by the Swedish National Infant Foundation from March 2008 to April 2010. Participants: 840 eligible participants who had experienced a stillbirth after the 22nd gestational week from 1955 to 2010 and completed an online questionnaire about their experiences. Methods: descriptive and inferential statistics. Findings: when mothers were presented the baby as a normal part of birth without being asked if they wanted to see, they more often reported that the experience was comfortable compared to mothers who were asked if they wanted to see the baby 86% vs. 76% (p=<0.01). The incitation of fear in mothers was 70% vs. 80% (p=0.02) in favour of mothers who were not asked. Furthermore the mothers who were not asked more often stated that it felt natural and good when compared to those who said staff asked if the mother wanted to see, 73% vs. 61% (p=0.07) and (78%) vs. (69%) p=0.19, respectively. A trend was seen toward more mothers feeling natural, good, comfortable, and less frightened if the provider engaged in 'assumptive bonding', that is the baby is simply and naturally presented to the mother without asking her to choose. Key conclusions: mothers of stillborn babies felt more natural, good, comfortable and less frightened if the staff supported assumptive bonding by simply offering the baby to the mother. Implications for practice: care providers should approach caring for grieving mothers with tenderness and humility, assuming that they will wish to see and hold their stillborn baby. © 2012 Elsevier Ltd.
Support during labour: First-time fathers' descriptions of requested and received support during the birth of their child
Volume 27, Issue 1, February 2011, Pages 67-73
Caroline Bäckström | Elisabeth Hertfelt Wahn
Objective: to explore how first-time fathers describe requested and received support during a normal birth. Design: qualitative research design. Ten first-time fathers were interviewed during the first postpartum week. Individual open-ended interviews were used to explore the fathers' descriptions, and the interviews were analysed using qualitative analysis. Setting: a labour ward at one hospital in a south-western county of Sweden in November and December 2006. Participants: first-time fathers who had experienced a normal birth at the hospital during the study period. Findings: the support described is presented as one main theme, 'being involved or being left out', which included four underlying categories: 'an allowing atmosphere', 'balancing involvement', 'being seen' and 'feeling left out'. Key conclusions: fathers perceived that they were given good support when they were allowed to ask questions during labour, when they had the opportunity to interact with the midwife and their partner, and when they could choose when to be involved or to step back. Fathers want to be seen as individuals who are part of the labouring couple. If fathers are left out, they tend to feel helpless; this can result in a feeling of panic and can put their supportive role of their partner at risk. Implications for practice: the results of this study could initiate discussions about how health-care professionals can develop support given to the labouring couple, with an interest in increasing paternal involvement. © 2009 Elsevier Ltd.
Volume 27, Issue 2, April 2011, Pages 138-145
Alison Teate | Nicky Leap | Sharon Schindler Rising | Caroline S E Homer
Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment. The aim of the pilot study was to determine whether it would be feasible to implement this model of care in Australia. Design: a descriptive study was conducted. Data included clinical information from hospital records, and antenatal and postnatal questionnaires. Setting: two metropolitan hospitals in Sydney, Australia. Participants: 35 women were recruited to the study and 33 ultimately received all their antenatal care (eight sessions) through five[CH1] CenteringPregnancy groups. Findings: difficulties with recruitment within a short study timeline resulted in only 35 (20%) of 171 women who were offered group antenatal care choosing to participate. Most women chose this form of antenatal care in order to build friendships and support networks. Attendance rates were high and women appreciated the opportunity and time to build supportive relationships through sharing knowledge, ideas and experiences with other women and with midwives facilitating the groups. The opportunity for partners to attend was identified as important. Clinical outcomes for women were in keeping with those for women receiving standard care; however, the numbers were small. Conclusion: the high satisfaction of the women suggests that CenteringPregnancy is an appropriate model of care for many women in Australian settings, particularly if recruitment strategies are addressed and women's partners can participate. Implications for practice: CenteringPregnancy group antenatal care assists women with the development of social support networks and is an acceptable way in which to provide antenatal care in an Australian setting. Recruitment strategies should include ensuring that practitioners are confident in explaining the advantages of group antenatal care to women in early pregnancy. Further research needs to be conducted to implement this model of care more widely. © 2009 Elsevier Ltd.
How can maternity services be developed to effectively address maternal obesity? A qualitative study
Volume 27, Issue 5, October 2011, Pages e170-e177
Nicola Heslehurst | Helen Moore | Judith Rankin | Louisa J. Ells | John R. Wilkinson | Carolyn D. Summberbell
Objective: to identify developments in maternal obesity services and health-care practitioners' views on how maternity services need to be further developed to be more effective in the care of obese pregnant women. Design: follow-up qualitative study using purposive sampling, interviews and focus groups. Setting: 10 maternity units in the North East Government Office Region of England, UK. Participants: 30 maternity unit health-care practitioners with personal experience of maternal obesity services. Measurements and findings: semi-structured interviews and focus groups were carried out with health-care practitioners representing each National Health Service trust in the region that provides maternity services to identify views on the barriers, facilitators, advantages and disadvantages of developing maternal obesity services, and how maternity services can be more effective in managing maternal obesity. Transcripts were analysed using thematic content analysis. Three dominant themes emerged: questioning maternal obesity service development; psychosocial issues and maternal obesity service development; and the way forward. Key conclusions: there has been a substantial improvement in the management of the health and safety aspects of maternal obesity over the last three years. However, more work is needed around the psychosocial issues, weight management and public health aspects of maternal obesity. Implications for practice: to meet the needs of obese pregnant women, maternity services should consider the transition of care between pregnancy and the postnatal period, improve communication between hospital and public health services, and develop services that will engage pregnant women to address their obesity. © 2010 Elsevier Ltd.
Volume 28, Issue 1, February 2012, Pages 45-51
Sabitri Sapkota | Toshio Kobayashi | Miyuki Takase
Background: the husband's presence at childbirth is universally accepted in industrialised nations, but the concept is still new within the cultural values and norms of Nepalese society. Understanding the cultural context surrounding the feelings and needs of Nepalese husbands will help to initiate realistic maternity education programmes. Objective: to explore husbands' experiences of supporting their wives during childbirth. Method: semi-structured interviews were conducted, and the data were analysed using thematic analysis. Setting: the Maternity and Neonatal Service Centre, a midwife-run birthing centre within a public maternity hospital in the capital of Nepal. Participants: twelve first-time expectant Nepalese fathers who had supported their wives during childbirth were interviewed in July 2009, within seven days of the birth. Findings: six themes were identified to explain the mixed experiences of the husbands in the labour or delivery room: (1) being positive towards attendance; (2) hesitation; (3) poor emotional reactions; (4) being able to support; (5) the need to be mentally prepared and (6) enlightenment. Husbands reflected on their experiences positively, despite profound hesitation and overwhelming emotions. Conclusions: the husbands' experiences revealed that Nepalese husbands tend to experience overwhelming emotional feelings in the labour or delivery room if they are allowed to attend the birth without prior preparation. Implications for practice: counselling for couples and education from the start of the pregnancy may reduce negative emotional experiences and improve satisfaction with the childbirth experience for both husbands and wives. © 2010 Elsevier Ltd.
Volume 28, Issue 1, February 2012, Pages 67-72
Jody R. Lori | Amy E. Starke
Objective: to conduct a secondary analysis of maternal death and near-miss audits conducted at the community and facility level to explore the causes and circumstances surrounding maternal mortality and severe morbidity in one rural county in Liberia, West Africa. Design: a non-experimental, descriptive design utilising maternal death and near-miss audit surveys was utilised for data collection. Thaddeus and Maine's Three Delays Model was used as a framework for analysis. Setting: one rural county in north-central Liberia. Participants: interviews were conducted with (1) women who suffered a severe morbidity or nearmiss event, (2) family members of women who died or presented with a severe morbidity, and (3) community members or health workers involved in the care of the woman. Measurements: (1) maternal mortality, (2) near-miss events, and (3) delays related to problem identification, transportation challenges and delays after reaching the referral site. Findings: 120 near-miss events and 28 maternal mortalities were analysed. 16% of all deliveries at the referral hospital were classified as near-miss events. Near-miss events were six times more common than deaths. The majority of women experiencing a near-miss event (85%) were in critical condition upon arrival at the hospital suggesting important delays were encountered in reaching the facility. Key conclusions: maternal mortality and near-miss audits allow exploration of medical and non-medical factors leading up to a severe complication or maternal death. Delays in reaching a referral hospital can have a significant impact on maternal survival rates. Implications for practice: audits can stimulate a change in clinical practice and help identify areas for county health departments to focus their scant resources. Audits can be used as a quality improvement tool in facilities. Results can be used to identify communities with high rates of delay to target educational programmes. © 2010 Elsevier Ltd.
'I want a choice, but I don't want to decide'-A qualitative study of pregnant women's experiences regarding early ultrasound risk assessment for chromosomal anomalies
Volume 28, Issue 1, February 2012, Pages 14-23
Ingvild Aune | Anders Möller
Objective: to increase our understanding of how pregnant women experience early ultrasound examination that includes a risk assessment for chromosomal anomalies and how such women perceive the test results. Design/setting: qualitative study at St. Olavs Hospital in Norway. Both pre- and post-examination interviews were conducted with ten pregnant women who underwent risk assessment for chromosomal anomalies. Grounded theory was used to analyse the results. Findings: the study generated a core category (I want a choice, but I don't want to decide), which related to the conflict between choice and decision making. There were also five main categories (existential choices, search for knowledge, anxiety, feeling of guilt and counselling and care). The main categories describe the complex feelings experienced by the women regarding the risk assessment. Factors contributing to the difficulty of choice included loss of control and coping, emotional connection to the fetus and social pressure. As the women sought independent choices without any external influence, they also felt greater responsibility. The women's understanding of the actual risk varied, and they used different types of logic and methods to evaluate the risk and reach a decision. Conclusions: the pregnant women in this study wanted prenatal diagnostic information and easy access to specialty services. Stress-related feelings and non-transparent information about the actual and perceived risks as well as personal moral judgments made the decision-making process complicated. Improved distribution of information and frequent contact with health professionals may help such women to make informed choices in accordance with their values and beliefs. © 2010 Elsevier Ltd.
Women want proactive psychosocial support from midwives during transition to motherhood: A qualitative study
Volume 27, Issue 1, February 2011, Pages e122-e127
Ans Seefat-van Teeffelen | Marianne Nieuwenhuijze | Irene Korstjens
Objective: to explore low-risk pregnant women's views on their preferences for psychosocial support from midwives during their transition to motherhood. Design: a qualitative design with focus-group interviews and thematic analysis of the discussions. Settings and respondents: 21 Dutch participants were included in three focus groups. Groups 1 (n=7) and 3 (n=8) consisted of pregnant women from four semi-urban midwifery practices, and group 2 (n=6) included participants from three urban midwifery practices. Findings: the women wanted to take responsibility for their own well-being during pregnancy. In addition to informal support, they explicitly expressed a need for professional support from their midwives when undergoing the transition to motherhood. They wanted informational and emotional support from their midwives that addressed psychological and physical changes during pregnancy. They expressed a strong desire to be informed during pregnancy of how to prepare physically and psychologically for birth, recovery and motherhood. They also wanted help with sifting and interpreting information and, ultimately, wanted to make their own choices. Key conclusions and implications for practice: during their transition to motherhood, healthy low-risk pregnant women want attentive, proactive, professional psychosocial support from midwives. They expect their midwives to oversee the transition period and to be capable of supporting them in dealing with changes in pregnancy and in preparing for birth and motherhood. © 2009 Elsevier Ltd.
Birth preparedness and skilled attendance at birth in nepal: Implications for achieving millennium development goal 5
Volume 29, Issue 10, October 2013, Pages 1206-1210
Rajendra Karkee | Andy H. Lee | Colin W. Binns
Objective: to assess birth preparedness in expectant mothers and to evaluate its association with skilled attendance at birth in central Nepal. Design: a community-based prospective cohort study using structured questionnaires. Setting: Kaski district of Nepal. Participants: a total of 701 pregnant women of more than 5 months gestation were recruited and interviewed, followed by a second interview within 45 days of delivery. Measurements: outcome was skilled attendance at birth. Birth preparedness was measured by five indicators: identification of delivery place, identification of transport, identification of blood donor, money saving and antenatal care check-up. Findings: level of birth preparedness was high with 65% of the women reported preparing for at least 4 of the 5 arrangements. It appears that the more arrangements made, the more likely were the women to have skilled attendance at birth (OR=1.51, p<0.001). For those pregnant women who intended to save money, identified a delivery place or identified a potential blood donor, their likelihood of actual delivery at a health facility increased by two to three fold. However, making arrangements for transportation and antenatal care check-up were not significantly associated with skilled attendance at birth. Conclusions: intention to deliver in a health-care facility as measured by birth preparedness indicators was associated with actual skilled attendance at birth. Birth preparedness packages could increase the proportion of skilled attendance at birth in the pathway of meeting the Millennium Development Goal 5. © 2013 Elsevier Ltd.