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Lois McKellar Julie Fleet Shona Dove 《Women and birth : journal of the Australian College of Midwives》2018,31(3):177-183
It’s more than just luck: A qualitative exploration of breastfeeding in rural Australia
Problem
Despite significant public health benefits, breastfeeding for six months continues to be challenging for women.Background
In the Mid North of South Australia, healthcare professionals were concerned that breastfeeding rates were lower than the national average and that a collaborative approach was needed to promote breastfeeding.Aim
To explore the experiences of women and health professional in the Mid North, to inform interventions to improve breastfeeding longevity.Method
Two focus groups were conducted to examine breastfeeding experience in the region. Focus group one included nine mothers who had breastfed more than six months and focus group two consisted of ten health professionals from the Mid North. Thematic analysis was used to analyse the data.Findings
Two overarching themes were identified; ‘breastfeeding: It’s more than just luck’ represented the voices of the mothers and ‘breastfeeding: It’s everybody’s business’ captured the discussion between the health professionals. Women described themselves as lucky while acknowledging that their own persistence, as well as positive support was vital. Health professionals identified education and support as key foci, and a need for a holistic approach to improve breastfeeding rates.Discussion
Breastfeeding should be understood as a relationship, in which broadly applied solutions do not necessarily influence longevity, particularly in rural communities. Strategies should also reflect a realistic picture of breastfeeding and safeguard against idealistic expectation of the experience.Conclusion
A holistic approach to improve breastfeeding rates is imperative. One of the most promising antidotes to the breastfeeding dilemma is the provision of midwifery continuity of care. 相似文献3.
Lena Bäck Ingegerd Hildingsson Carina Sjöqvist Annika Karlström 《Women and birth : journal of the Australian College of Midwives》2017,30(1):e32-e38
Background
Midwives have a significant impact on the clinical outcome and the birthing experience of women. However, there has been a lack of research focusing specifically on clinical midwives’ learning and development of professional competence.Aim
The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence.Methods
A qualitative study based on focus groups with midwives employed in maternity services.Findings
Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding. The meaning of competence is to feel safe and secure in their professional role. There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident. Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field. The midwives felt they were not seen as individuals, and this system made them feel split between different assignments.Discussion
External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning.Conclusions
Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident. 相似文献4.
Heidi Preis Michal Eisner Rony Chen Yael Benyamini 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e110-e117
Problem
Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously.Background
Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare.Aim
To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options.Methods
Longitudinal observational study including 342 first-time expectant mothers recruited at women’s health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth.Findings
Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth.Discussion
Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease.Conclusion
Women’s beliefs should be recognized and birth preferences respected. 相似文献5.
Jeni Stevens Virginia Schmied Elaine Burns Hannah G. Dahlen 《Women and birth : journal of the Australian College of Midwives》2018,31(6):453-462
Problem
Providing skin-to-skin contact in the operating theatre and recovery is challenging.Background
Barriers are reported in the provision of uninterrupted skin-to-skin contact following a caesarean section.Aim
To explore how health professionals’ practice impacts the facilitation of skin-to-skin contact within the first 2 h following a caesarean section.Methods
Video ethnographic research was conducted utilising video recordings, observations, field notes, focus groups and interviews.Findings
The maternal body was divided in the operating theatre and mothers were perceived as ‘separate’ from their baby in the operating theatre and recovery. Obstetricians’ were viewed to ‘own’ the lower half of women; anaesthetists were viewed to ‘own’ the top half and midwives were viewed to ‘own’ the baby after birth. Midwives’ responsibility for the baby either negatively or positively affected the mother's ability to ‘own’ her baby, because midwives controlled what maternal-infant contact occurred. Mothers desired closeness with their baby, including skin-to-skin contact, however they realised that ‘owning’ their baby in the surgical environment could be challenging.Discussion
Health professionals’ actions are influenced by their environment and institutional regulations. Further education can improve the provision of skin-to-skin contact after caesarean sections. Skin-to-skin contact can help women remain with their baby and obtain a sense of control after their caesarean section.Conclusion
Providing skin-to-skin contact in the first 2 h after caesarean sections has challenges. Despite this, health professionals can meet the mother's desire to ‘own’ her baby by realising they are one entity, encouraging skin-to-skin contact and avoiding maternal and infant separation. 相似文献6.
Yael Benyamini Maya Lila Molcho Uzi Dan Miri Gozlan Heidi Preis 《Women and birth : journal of the Australian College of Midwives》2017,30(5):424-430
Problem
Rates of medical interventions in childbirth have greatly increased in the Western world.Background
Women’s attitudes affect their birth choices.Aim
To assess women’s attitudes towards the medicalization of childbirth and their associations with women’s background as well as their fear of birth and planned and unplanned modes of birth.Methods
This longitudinal observational study included 836 parous woman recruited at women’s health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at <28 weeks gestation when filling in the questionnaire were asked to fill in a second one at ～34 weeks. Phone follow-up was conducted ～6 weeks postpartum to assess actual mode of birth.Findings
Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births.Discussion
Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned.Conclusion
Understanding women’s views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth. 相似文献7.
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Megan Cooper Jane Warland Helen McCutcheon 《Women and birth : journal of the Australian College of Midwives》2018,31(3):184-193
Background
There is little published research that has examined practitioners’ views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance.Aims
The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option.Methods
Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion.Findings
Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women’s informed choice.Conclusion
Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby.Ethical considerations
The Human Research Ethics Committee of the University of South Australia approved the research. 相似文献9.
Predictors of women’s positive childbirth pain experience: Findings from an Icelandic national study
Sigfridur Inga Karlsdottir Herdis Sveinsdottir Hildur Kristjansdottir Thor Aspelund Olof Asta Olafsdottir 《Women and birth : journal of the Australian College of Midwives》2018,31(3):e178-e184
Background
Pain in childbirth has been identified as one of the major components in the childbirth experience and an important topic that needs to be addressed during pregnancy, birth and the after-birth period.Aim
The aim of the study was to describe women’s childbirth pain experience and to identify predictors of women’s positive childbirth pain experience.Method
A population-based cross-sectional cohort study design was implemented, with convenient consecutive sampling, stratified according to residency. Pregnant women were recruited through 26 health care centers. Participants were sent a questionnaire by mail during early pregnancy and another one five to six months after childbirth. A multiple regression analysis was done, with women’s childbirth pain experiences as the dependent variable.Findings
Altogether 726 women participated in the study, with a response rate of 68%. The strongest predictors for women’s positive childbirth pain experience were positive attitude to childbirth during pregnancy; support from midwife during childbirth; use of epidural analgesia and low intensity of pain in childbirth.Discussion
The majority of the women in the study experienced childbirth pain as a positive experience, which is in line with studies that have demonstrated that pain in childbirth is different from other kinds of pain. In addition to epidural use as a predictor for positive childbirth pain experience, many other strong predictors exist and must be acknowledged.Conclusion
When planning pregnancy and childbirth services, predictors of positive experience of childbirth pain should be considered and investigated further. 相似文献10.
Hazel Keedle Virginia Schmied Elaine Burns Hannah Grace Dahlen 《Women and birth : journal of the Australian College of Midwives》2018,31(1):69-79
Background
Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean.Methods
This paper reports on a meta-ethnographic review of 20 research papers exploring women’s experience of vaginal birth after caesarean in a variety of birth locations. Meta-ethnography utilises a seven-stage process to synthesise qualitative research.Results
The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their vaginal birth after caesarean. Achieving a vaginal birth after caesarean was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’.Conclusion
Women undergo a journey from their previous caesarean with different positive and negative experiences as they move towards their goal of achieving a vaginal birth after caesarean. This ‘journey from pain to power’ is strongly influenced by both negative and positive support provided by health care practitioners. Positive support from a health care professional is more common in confident practitioners and continuity of care with a midwife. 相似文献11.
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Christine A. Marsh Jenny Browne Jan Taylor Deborah Davis 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e1-e11
Background
Being involved in any child protection system is complex and multifaceted and none more so than in non-voluntary Assumption of Care which occurs in New South Wales when, for child protection concerns, the Department of Family and Community Services removes a newborn baby from her/his mother.Objective
This research studied childbearing women’s and professionals’ experiences of Assumption of Care at birth to increase understanding of individual participants’ stories, how they made sense of meanings and how these experiences framed their lives.Method
A narrative inquiry framework guided interviews with four groups: childbearing women, midwives, social workers and Family and Community Services case managers. Holistic form was used for reading, interpreting and analysing the narratives.Findings
This research found unwanted emotional (isolation, shame, guilt, loss, disenfranchised grief) and physical consequences (depression, substance abuse complications) for women experiencing an Assumption of Care at the time of birth. There were also conflicting ethical and moral positions for the professionals involved. The use/abuse of power, concealment of facts and disenfranchised grief were identified as intertwined plots that caused or increased tensions.Discussion
Both the women and the professionals felt pressure from trying to achieve competing and overlapping roles. The unwanted effects of Assumption of Care are exacerbated by the current child protection and maternity care systems.Conclusion
To address the tensions raised in this study, we suggest a two-fold change to maternity care for women at risk of an Assumption of Care: a therapeutic justice model of maternity care and continuity of midwifery care with a dedicated midwife. Introducing these changes could increase women’s and children’s safety and wellbeing. 相似文献13.
Megan Cooper Helen McCutcheon Jane Warland 《Women and birth : journal of the Australian College of Midwives》2017,30(5):431-441
Background
Accessibility of water immersion for labour and/or birth is often dependent on the care provider and also the policies/guidelines that underpin practice. With little high quality research about the safety and practicality of water immersion, particularly for birth, policies/guidelines informing the practice may lack the evidence necessary to ensure practitioner confidence surrounding the option thereby limiting accessibility and women’s autonomy.Aim
The aims of the study were to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/guideline facilitates the option for labour and birth.Method
Phase one of a three-phase mixed-methods study critically analysed 25 Australian water immersion policies/guidelines using critical discourse analysis.Findings
Policies/guidelines pertaining to the practice of water immersion reflect subjective opinions and views of the current literature base in favour of the risk-focused obstetric and biomedical discursive practices. Written with hegemonic influence, policies and guidelines impact on the autonomy of both women and practitioners.Conclusion
Policies and guidelines pertaining to water immersion, particularly for birth reflect opinion and varied interpretations of the current literature base. A degree of hegemonic influence was noted prompting recommendations for future maternity care policy and guidelines’.Ethical considerations
The Human Research Ethics Committee of the University of South Australia approved the research. 相似文献14.
Susanne Åhlund Sofia Zwedberg Ingegerd Hildingsson Malin Edqvist Helena Lindgren 《Women and birth : journal of the Australian College of Midwives》2018,31(2):e115-e121
Problem and background
In an earlier research project midwives were asked to perform women-centered care focusing on the assumption that the physiological process in the second stage of labour could be trusted and that the midwives role should be encouraging and supportive rather than instructing. There is no knowledge about how midwives participating in such a research project, uses their skills and experience from the study in their daily work.Aim
The aim in this study was to investigate how midwives experienced implementing woman-centered care during second stage of labour.Methods
A qualitative study was designed. Three focus groups and two interviews were conducted. The material was analysed using content analysis.Findings
The participating midwives’ experiences were understood as increased awareness of their role as midwives. The overarching theme covers three categories 1) establishing a new way of working, 2) developing as midwife, 3) being affected by the prevailing culture. The intervention was experienced as an opportunity to reflect and strengthen their professional role, and made the midwives see the women and the birth in a new perspective.Conclusions
Implementing woman-centered care during second stage of labour gave the midwives an opportunity to develop in their professional role, and to enhance their confidence in the birthing women and her ability to have a physiological birth. To promote participation in, as well as conduct midwifery research, can enhance the development of the midwives professional role as well as contribute new knowledge to the field. 相似文献15.
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Lindsay Cole Amanda LeCouteur Rebecca Feo Hannah Dahlen 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e95-e101
Problem
Studies of women’s childbirth preferences repeatedly show that natural birth remains highly valued, yet the majority of births involve some form of medical intervention. Reasons for this lack of correspondence have typically been investigated through interviews and focus-groups with women. Relatively little research explores the ways in which women describe their experiences of childbirth outside of such research settings.Background
Most maternity services promote woman-centred care, whereby women are encouraged to take active roles in deciding how to give birth. However, recent research indicates that women often report feeling disempowered during labour and birth in hospital settings.Aim
We sought to examine how women account for use of medical intervention in hospitals by examining narratives posted on online discussion forums.Method
A thematic analysis of 106 publically available birth stories, sourced using the Internet search terms ‘birth story’, and ‘birth narrative’, was undertaken.Findings
Medical interventions in childbirth were routinely described as unwanted, yet as unavoidable, and two types of account were typically drawn on to explain their use: Protection of the baby/mother; and inflexible hospital policy/practice. We examine these two types of account, focusing on how their design oriented to the discordance between mothers’ reported desires for a natural birth, and their experiences in hospital.Conclusion
The experience of medical intervention in childbirth is routinely oriented to as a matter that requires explanation or account in online birth narratives. Women repeatedly referred to their preference to avoid intervention, but described being unable to do so in hospital. 相似文献20.
Diana Jefferies Debbie Horsfall Virginia Schmied 《Women and birth : journal of the Australian College of Midwives》2017,30(1):e24-e31