Academic literature on the topic 'RT Nursing : RG Gynecology and obstetrics'

Different patterns of care and a range of lead professionals have influenced care provision in relation to childbirth. The role of a midwife has been influenced by historical factors, research and service changes within the National Health Service. Little is known about how the role of the midwife is perceived. This study explored the views of women and midwives relating to the role of the midwife. Mixed methods of data collection were utilised. In the first phase of the study 4 focus groups (a total of 9 women) were performed. In the second phase of the study longitudinal interviews were conducted. A total of 10 women participated in this phase. The interviews were performed at 4 different time points of their childbearing experience. A total of 40 interviews were conducted. Additionally diaries from the 10 women were completed, to capture information between the interview time points. Following the initial exploratory phase , a postmodern feminist technoscience theoretical stance underpins the second phase of this study; in particular it draws on the work of Donna Haraway. Haraway’s notion of ‘situated knowledges’ provides the opportunity to locate the views of women and midwives. This provided the opportunity to utilise her notions of ‘modest witness’, ‘cyborg’, ‘goddess’, ‘material-semiotic’ and connect to their perceptions. One facet of the study’s originality lies in matching the women’s and midwives’ ‘situated knowledges’, by interviewing the 10 midwives who were present at each of the 10 women’s birth experiences. Analysis using thematic networks was used to construct basic, organising and global themes. The findings indicate that the use of technology has a powerful influence on women’s perceptions in relation to the role of the midwife. Women and midwives connected with technology through material-semiotic connections, which has led to cyborgification within a consultant led model of care and birth environment. Women overwhelmingly perceived that birth was safer in hospital, due to the presence of technology and doctors; doctors were perceived as the decision maker and the midwife as a ‘handmaiden’. ‘Being’ and ‘doing’ midwives were recognised. The midwives were all situated in a different place within these categories, depending on their values and experiences. Generally the ‘doing’ midwives were free to ‘do’, as they supported the biomedical culture of the environment they were working in. ‘Being’ midwives supported the natural elements of the birth process, they adapted to the role of a ‘hybrid’ midwife within a consultant led environment, interchanging their technological skills for normality skills when they were secluded from interferences of the medicalised culture. This study provides evidence to inform practice developments within midwifery and makes a contribution to feminist theorising. It asserts that the culture of childbirth in contemporary society is technological, medically led and the normal birth process is not valued. This has contributed to cyborgification of women and midwives within a consultant led setting. An advancement of Haraway’s theory has been made from the emergence of the way in which the ‘being’ midwife morphs into a ‘doing’ midwife when she feels that she has to conform to the medicalised culture of the environment or from women’s expectations of their birth experience.

Introduction: Clinical Leadership is a way of facilitating change and increasing the quality of care at the front line of practice. However, the failure of midwifery leadership and being designated an oppressed group questions the ability of midwives to practice as clinical leaders in the labour ward environment. Whilst there is some research relating to clinical leadership in nursing, no research exists that investigates the clinical leadership of midwives who are directly involved in giving care to women. Aim: The aim of this research was to explore clinical leadership on the labour ward and to develop an understanding of the associated characteristics of clinical leadership. The attributes that delineated effective clinical leadership were examined in addition to associated professional discourses and relationships of power that existed on the labour ward. Methods: A critical ethnographic approach was undertaken on the labour ward of a district general hospital and a teaching hospital in the North of England, using participant observation and semi-structured interviews. A total of sixty-nine hours of participant observation was undertaken. A purposive sample of 30 midwives were interviewed in the first instance and further interviews were undertaken with 18 midwives who were nominated as effective clinical leaders by the midwives in the initial interviews. Data were examined through the lens of Bourdieu’s Theory of Practice. Findings: Clinical leadership existed at different levels on the labour ward, however, midwives mostly identified LWCs in this role. LWCs’ clinical leadership was necessary, contradictory, gendered, socialised and unsupported within the hierarchical, high-risk and fearful labour ward. A combination of heroic and values-based clinical leadership was required to maintain safety and facilitate productivity. Heroic leadership, the high level of accountability and symbolic capital invested in the LWC led to a loss of autonomy for other midwives, a lack of dissent and difficulty initiating changes in practice. The contradictory nature of the LWCs’ work and a lack of support led to them experiencing both emotional and physical stress. Within an increasingly highrisk labour ward environment the LWC clinical leaders experienced professional misrecognition and discrimination that resulted in dysfunctional inter-professional relationships and keeping the obstetricians away from women. Conclusion: A high level of responsibility invested in the LWC combined with socialisation led to heroic leadership which fostered dependency prevented change and innovation. Inequalities of power and dysfunctional relationships were symptoms of a system failure that does not support midwifery practice or woman-centred care. Recommendations are made for policy, education, practice and future research.

The desire for, and provision of, cross border reproductive services (CBRS) (i.e. gamete donation and surrogacy) is a growing international phenomenon. CBRS describes the travel by infertile patients from one country or jurisdiction where access to treatment is limited or unavailable to another country or jurisdiction to seek infertility treatment. There are numerous reasons for CBRS and it is an under- researched and undertheorised area of health research. The aim of this thesis was to explore patients’ motivations for and experiences of CBRS. This study provided themes on the decision making process of CBRS patients and contextualised them within a partial trans-Theoretical Model. Data regarding CBRS were collected from 26 international participants by means of asynchronous email in-depth semi-structured interviews via two international infertility networks. SPSS was used to analyse the quantitative data whereas NVivo 10 software aided the systematic thematic coding method within an Interpretative Grounded Theory. Participants’ motivations for and experiences of CBRS are complex. Seven stages of patients’ infertility journeys emerged: 1. Pre-contemplation: participants had no awareness of their own infertility; 2. Contemplation: participants became aware of their infertility and treatment at home and / or CBRS; 3. Preparation: participants researched CBRS using internet/infertility networks; 4. Action: participants took specific steps to initiate CBRS; 5: Maintenance: participants’ expectations and experiences were important to whether or not they would continue with CBRS; 6: Exit: some participants successfully built their family. Others’ overall experience was negative, their expectations were not met and they decided to quit treatment; 7: Re-engagement: some participants re-engaged with infertility treatment; some participants re-considered their decision regarding infertility treatment either at home or CBRS. A partial Trans-Theoretical Model could explain some of the decision-making process in seeking CBRS. Future research is needed to explore the implications of CBRS for patients, donors, offspring and healthcare systems.

The effects of undertaking a regular exercise programme during and following pregnancy were investigated with healthy primigravid women within Ayrshire Central Hospital, Irvine. A randomised control trial was used with subjects being randomly assigned to either a control group who continued with the existing antenatal education programme or an exercise group who had the addition of participating in an aerobic exercise programme. In early pregnancy, no significant differences were found between the groups in relation to activity levels or mean scores of psychological variables with the exception of the control group having significantly more positive scores for perceptions of body image. During and following pregnancy, the exercise group maintained their scores on all psychological variables i.e. perceptions of coping assets (positive psychological well-being), coping deficits (negative psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, sex and pregnancy. In contrast, the control group tended to have significant reductions in perceptions of the ability to cope (positive psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, pregnancy and sex during pregnancy in addition to an increase in perceived coping deficits (negative psychological well-being).The exercise group participated in a significantly higher number of episodes of physical activity sessions than the control group. No significant relationship was noted between frequency of physical activity and responses to psychological indictors in post pregnancy. In conclusion, women who participated in regular physical activity tended to have a protection against a reduction of psychological well-being as measured by a variety of psychological constructs. The maintenance in psychological well-being was experienced both during and following pregnancy and there was no indication of any risk to the pregnancy or the baby. This was in contrast to the significant reduction in psychological well-being experienced by the women in the control group during the same period.

The postnatal period is an important and extremely vulnerable time for new mothers and their infants. Research has outlined the considerable extent of maternal physiological and psychological morbidity following childbirth. The underreporting and undiagnosed aspect of this morbidity has also been highlighted. Newborn infants are totally dependent on their needs being met and are also at risk of newborn conditions particularly if they are undiagnosed, for example neonatal jaundice. There is however, mounting evidence regarding the lack of postnatal support from health professionals, with women continuing to report their dissatisfaction with postnatal care. Research into postnatal care is pre-dominantly quantitative and clinically focused. Few empirical studies have examined the meaning women give to their postnatal care experiences. This research aims to generate a deeper understanding of the meanings, and lived experiences of postnatal care. In addition, it aims to reveal future possibilities to enhance women’s postnatal care experiences. Initially, an in-depth examination of relevant literature is undertaken followed by a presentation of the process and findings from a qualitative meta-synthesis. An in-depth exploration of Martin Heidegger’s biography and explication of his philosophy is then outlined. This research is a Heideggerian hermeneutical phenomenological study of Irish women’s aspirations for, and experiences of, postnatal care. Purposive sampling is utilised in this research, which was undertaken in two phases. Phase one involved group interviews over three different time periods (between 28-38 weeks gestation, 2-8 weeks and 3-4 months postnatally), with a cohort of primigravid women and a cohort of multigravid women. The second phase involved recruiting two further cohorts of primigravid and multigravid women who participated in individual in-depth interviews over the same longitudinal period. In total nineteen women completed the study. Thirty-three interviews were held in total. The data analysis is guided by Crist and Tanner’s (2003) interpretative hermeneutic framework. The women’s aspirations/expectations for their postnatal care are represented through three interpretive themes: ‘Presencing’, ‘Breastfeeding help and support’ and ‘Dispirited perception of postnatal care’. In addition, five main themes emerged from the data and capture the meanings the women gave to their lived experiences of postnatal care: ‘Becoming Family’, ‘Seen or not seen’, ‘Saying what matters’, ‘Checked in but not always checked out’ and ‘The struggle of postnatal fatigue’. The original insights from this research clearly illuminate the vulnerability women face in the days following birth. A further in-depth interpretation and synthesis of the findings was undertaken. This philosophical-based discussion drew from the work of Heidegger (1962) and Arendt (1998). Engaging with these theoretical perspectives contributed to a new understanding about why some women within a similar context, have positive experiences of postnatal care while others do not. As such, the very nature that midwives and other postnatal carers are human beings has an influence on a woman’s experience of her care. These carers, in their exposition of ‘being’ have the ability to demonstrate ‘inauthentic’ or ‘authentic’ caring practices. It is those who choose to be ‘the sparkling gems’ that are the postnatal carers who make a difference and stand out from the others. For the women in this study, their postnatal care experiences mattered. While some new mothers reported positive and meaningful experiences others revealed experiences which impacted unnecessarily. The relevance of these findings, recommendations and suggestions for future research are offered.

Regular breastfeeding surveillance is essential to determine to what extent national breastfeeding targets are being met and how breastfeeding practices change over time. There have been irregular infant feeding studies or national surveys carried out in Kuwait so it is difficult to assess secular trends in breastfeeding practices. The objective of the Kuwait Infant Feeding Study (KIFS) was to identify the incidence and prevalence of breastfeeding up to 26 weeks postpartum among a population of women living in Kuwait and to identify the factors associated with the initiation and duration of breastfeeding. A sample of 373 women recruited shortly after delivery from four hospitals in Kuwait completed a structured, interviewer-administered questionnaire and follow-up telephone interview at 6, 12, 18 and 26 weeks postpartum. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding and survival analysis was used to examine the duration of breastfeeding. In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed prior to hospital discharge, the remainder of breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. At six months of age, 39% of mothers were still breastfeeding but none of the women were fully or exclusively breastfeeding. The median duration of any breastfeeding duration was 13.9 weeks. 2 Breastfeeding at discharge from hospital was independently positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery. Mothers originally from other Arab countries were more likely to initiate breastfeeding in hospital than Kuwaiti mothers. Women whose husbands worked in sales or clerical occupations and Kuwaiti national mothers were at higher risk of early breastfeeding termination. Women whose husband or own mother preferred breastfeeding, breastfed for longer than those women whose husbands or mothers preferred formula feeding or were ambivalent about how they fed the infant. Hospital-related factors including time of first feeds, type of first feed, age of introducing a pacifier and feeding on demand were significantly associated with breastfeeding duration. The results of this study indicate that while breastfeeding is almost universally initiated, very few women achieve the WHO recommendations of exclusive breastfeeding to 6 months of age. The reasons for the high use of prelacteal and supplementary formula feeding warrant further investigation. Data collected in this study will contribute to the limited breastfeeding surveillance data available for Kuwait and inform future public health policy. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding among mothers in Kuwait.

Waterbirths have been available in the United Kingdom as a method of pain relief for childbirth for over two decades but the neonatal safety of birth in water remains unevaluated. Opponents of a waterbirth randomised controlled trial state randomisation would undermine women’s childbirth experience. In addition, little is known about midwives’ attitudes to waterbirths. This thesis addresses some of the lack of evidence by reporting the findings of two studies which had three aims: to investigate the feasibility of a waterbirth RCT to assess the effects of a waterbirth on the neonate, to explore women’s thoughts about participation and whether randomisation affects women’s satisfaction with their childbirth experience and to assess midwives’ attitudes to waterbirths. The first study involved a RCT with a ‘preference arm’. Eighty women were recruited: 60 in the RCT and 20 in the ‘preference arm’. Women were asked to complete questionnaires to assess their expectations for, and satisfaction with, their childbirth experience: at recruitment, after the birth and 6 weeks after the birth. Women in the randomised arm indicated willingness to partake but questioned midwives’ commitment to offering waterbirths. A Q Methodology study was undertaken to identify factors which influence midwives’ (n=31) attitudes towards waterbirths. Four factors were identified: Motivation, Risk Assessment, Confidence, Safety. Conclusion: It is feasible to organise a larger RCT to assess neonatal safety and women would be supportive. Strategies would be required to ensure midwives are confident and supportive of the waterbirth service.

The vision for maternity services focuses on women-centred care with choice, control and promoting normality at its centre, thus emphasising the need to empower women to make choices and decisions regarding their care in labour and birth. Some women will choose the medical model of care, however others prefer to be in control and choose to use non-pharmacological alternatives for pain control in labour such as Transcutaneous Electrical Nerve Stimulation (TENS). TENS has enabled the provision of non-invasive, mobile, self-controlled pain relief for women in labour and is used extensively by women in the UK who, when asked, assess it favourably and say they would use it again. Currently the available literature on TENS fails to consider individual women’s experiences of using TENS for labour and birth, this study therefore seeks to redress this balance. Set in the south of England, the study uses Interpretative Phenomenological Analysis (IPA) in order to explore the experiences of twenty purposively selected women, who were interviewed to expose their in-depth experiences of using TENS for pain control in labour and birth. The analysis of the verbatim transcripts revealed comprehensive findings ensuring an idiographic focus along with making claims for the larger group of women. In this study women used TENS as part of a combination of more natural pain control or as a ‘sole’ form of pain control for labour and birth. TENS was recognised as being part of a wider strategy for the maintenance of control in labour and normal birth for women. A super-ordinate theme of ‘control’ emerged from the data particularly relating to ‘internal control of self’, ‘external control of others’ and ‘control of the TENS machine’. Women’s positive experiences were enhanced by remaining mobile, using drug free pain control, being knowledgeable, having partners’ and midwives’ support, being distracted from their pain and trusting in TENS. By uncovering a group of women’s in-depth experiences of using TENS for pain control in labour and birth this study has filled a “gap” in the knowledge base. In addition, the findings suggest that TENS was identified as an ‘enabling mechanism’ for the women in order to be in control of a normalised birth. Women were able to maintain their independence, make decisions and actively take part in their pain control using TENS.

Breast milk is acknowledged and recommended as the best food for babies by the World Health Organization. However, globally the proportion of mothers who breastfeed is still low and this is particularly the case in Thailand. The aim of this study is to improve women’s ability to breastfeed. A two phase study was designed. Phase I was to better understand women’s experiences and breastfeeding support needs, which formed the development of the ‘Breastfeeding Support Package’. The package, which consisted of the tool and leaflets, was to be administered by the nurses with the postpartum women. Phase II aimed to explore mother’s and nurses’ experiences following the use of the package. A pragmatic qualitative approach was used throughout. A government hospital in Bangkok, Thailand, was the setting for this research. Purposive sampling was used to recruit the participants for both phases of the study. In Phase I, semi-structured interviews of 17 mothers who visited the Family Planning Clinical, post-delivery, were undertaken. Thematic analysis was used to examine the data. For phase II, three groups of participants were involved: five participants from phase 1, five postpartum women and five nurses working on the postpartum ward. Telephone interviews were used to assess face validity to the tool while semi-structured interviews were used to investigate mothers’ and nurses’ experiences regarding the use of the package. Three themes that contributed to women’s experience of breastfeeding were ‘knowledge and attitude towards breastfeeding’, ‘practicality’ and ‘support’. Three themes that contributed to ‘women’s needs of breastfeeding support’ were ‘knowledge’, ‘attitude’, and ‘practice’. The use of the package could open a ‘platform to communication’ regarding women’s needs and act as a ‘platform to support’ for nurses. The postpartum women were able to better communicate their needs regarding breastfeeding support with the nurses, as well as receiving the support they required. The packaged worked well with present conditions and environment at the postpartum ward of the hospital.

Background In 2014, 27.0% of births in England and Wales were to mothers born outside of the UK. Compared to their white British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Although existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes health professionals report difficulty in providing services to minority ethnic and migrant women. However little research has explored the factors contributing to the midwife-woman relationship for migrant and minority ethnic women. Research Aims To explore relationships between migrant Pakistani women and midwives in South Wales; focusing on the factors contributing to these relationships, and the ways in which these factors might affect women’s experiences of care. Method A focused ethnography in South Wales; semi-structured interviews with 10 migrant Pakistani participants (eight pregnant women, one husband and one mother) and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal booking appointments, and longitudinal reviewing of relevant media outputs, such as UK news reports of issues relating to migrant people. Data were analysed concurrently with collection using thematic analysis. Findings The midwife-woman relationship was important for participants’ experiences of care. A number of social and ecological factors influenced this relationship; including family relationships, culture and religion, differing healthcare systems, authoritative knowledge, and communication of information. However, differences were seen between midwives and women in the perceived importance of these themes. Findings therefore suggest that in order to understand how midwife-woman relationships are created and maintained, more needs to be done to recognise and address these differences. Due to the complexity of the relationships between themes a social ecological model of relationships is forwarded as a means of visually capturing the complexity of the findings, as well as potentially shaping midwifery education and clinical midwifery practices. Conclusions and Implications Findings from this study provide new theoretical insights into the complex social and ecological factors at play during maternity care for migrant Pakistani women. These findings can therefore be used to create meaningful dialogue between women and midwives, encourage collaborative learning and knowledge production, and facilitate future midwifery education and research.