Parturescence: A theorisation of women’s transformation through childbirth

ProblemThe potential for positive transformation through giving birth is under-acknowledged and poorly understood.Aim and methodBy drawing on theories of new feminist materialism to open up ways of thinking about childbirth and maternity care, we discuss how aspects of the process of matrescence, a woman’s ‘mother-becoming’, pertain to women’s opportunities in childbirth. We introduce the term, ‘parturescence’, as a moniker for the opportunity for ‘becoming’, and therefore transformation, offered in birth giving.Results and discussionUsing Davies’ interpretation of Bergson’s lines of descent and ascent we suggest the conditions of a woman’s parturescence (whether birth giving will result in a positive or negative transformation) is enabled by ‘with woman’ midwifery care. The intra-action between this care, and the materiality of birth – the pain and exhaustion women experience in labour and birth, results in a rematerialisation of who and what women are and the opportunity for women’s transformation.ConclusionThe development of this theory of parturescence unifies disparate aspects of maternity care and birth literature, provides insight into the potential mechanisms and conditions that impact women’s parturescence, and suggests that birth, including the challenging and destabilising parts, is not just for the production of a baby, but also a site of women’s ‘becoming’.     

Midwives’ practices and knowledge about fear of childbirth and postpartum posttraumatic stress disorder

BackgroundWomen suffering from fear of childbirth and postpartum posttraumatic stress disorder are often not recognised by health care professionals.AimTo evaluate practices, knowledge and the attitudes of midwives towards women with fear of childbirth and postpartum posttraumatic stress disorder.MethodsA cross-sectional study was performed amongst midwives who work in community practices and hospitals in the Netherlands with the use of a questionnaire purposefully designed for this research aim.Findings257 midwives participated in the study, of whom 217 completed all items in the questionnaire. Midwives were better equipped to answer knowledge questions concerning fear of childbirth than posttraumatic stress disorder (regarding symptomatology, risk factors, consequences and treatment). When tending to women with fear of childbirth or (suspected) postpartum posttraumatic stress disorder, most midwives referred to another caregiver (e.g. psychologist). Most midwives expressed a positive and compassionate attitude towards women with fear of childbirth and postpartum posttraumatic stress disorder.DiscussionThe majority of midwives are well informed with respect to fear of childbirth, but knowledge of important aspects of postpartum posttraumatic stress disorder is often lacking. Midwives report no crucial issues related to their attitudes towards women with fear of childbirth and posttraumatic stress disorder. Most midwives provide adequate organisation of care and support.ConclusionMidwives should acquire more in depth knowledge of fear of childbirth and postpartum posttraumatic stress disorder. This can be achieved by including the two conditions in the program of midwifery education.     

Midwives’ knowledge of pre-eclampsia management: A scoping review

BackgroundPre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries.AimTo identify what midwives’ around the world know about pre-eclampsia management.MethodsA scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes.FindingsFour themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia.ConclusionWorldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives’ knowledge.     

Midwives’ comprehension of care for women with intellectual disability during pregnancy and childbirth: An open-ended questionnaire study in Sweden

BackgroundFew studies have investigated midwifery care for women with intellectual disability (ID).AimTo gain a deeper understanding of midwives’ comprehension of care for women with ID during pregnancy and childbirth.MethodsA cross-sectional study among 375 midwives at antenatal clinics and delivery wards in Sweden. Findings 2476 quotations were sorted into six categories: information; communication and approach; the role of the midwife; preparing for and performing interventions and examinations; methods and assessments; and organisation of care. The midwives affirmed that individual, clear and repeated information together with practical and emotional support was important for women with ID. The midwives planned the care as to strengthen the capacity of the women, open doors for the unborn child and reinforce the process of becoming a mother. Extra time could be needed. They tried to minimise interventions. The midwives felt a dual responsibility, to support the mother–child contact but also to assess and identify any deficits in the caring capacity of the mother and to involve other professionals if needed.ConclusionsThe midwives described specially adapted organisation of care, models of information, practical education and emotional support to facilitate the transition to motherhood for women with ID. They have a dual role and responsibility in supporting the woman, while making sure the child is properly cared for. Healthcare services should offer a safe and trusted environment to enable such midwifery care. When foster care is planned, the society should inform and co-operate with midwives in the care of these women.     

‘They follow the wants and needs of an institution’: Midwives’ views of water immersion

BackgroundA midwife’s ability to fully support women’s autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman’s agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision.ObjectivesA three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice.MethodsCritical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results.FindingsFindings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife’s ability to offer and the woman’s decision to use water immersion under the themes ‘the reality of the system’, ‘the authoritative ‘others’’ and ‘the pseudo decision-makers’. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care.ConclusionsThe insight gained from examining midwives’ views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.     

Midwives’ provision of health promotion in antenatal care: A qualitative explorative study

ProblemStudies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care.BackgroundAntenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important.AimTo explore how Danish midwives experienced antenatal care and practiced health promotion.MethodsMidwives undertaking antenatal care were interviewed individually (n = 8) and two focus groups (n = 10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper’s health promotion practice Framework for midwives were used to analyse the midwives’ health promotion approach.FindingsTwo major themes were highlighted. Theme 1: ‘The antenatal care context for health promotion’ described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: ‘The health promotion approach in antenatal care’ described both midwife-focused and woman-focused approaches to pregnant women’s health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time.DiscussionThe midwives’ experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care.ConclusionMidwives mainly had a midwife-focused approach. To further promote women’s health, midwives need to focus on a woman-focused approach.     

Midwives being ‘with woman’: An integrative review

Background

Midwives being ‘with woman’ is embedded in professional philosophy, standards of practice and partnerships with women. In light of the centrality of being ‘with woman’ to the profession of midwifery, it is timely to review the literature to gain a contemporary understanding of this phenomenon.

Midwives’ role in the provision of maternal and childhood immunisation information

ProblemInactivated influenza vaccine and diphtheria-tetanus acellular pertussis vaccine are routinely recommended during pregnancy to protect women and their babies from infection. Additionally, the hepatitis B vaccine is recommended for infants within the first week of life; however, little is known about midwives’ experiences of recommending and delivering these immunisations.BackgroundMidwives are a trusted source of vaccine information for parents and the confident provision of information about immunisation during antenatal clinic visits has been found to increase the uptake of antenatal and childhood vaccines.AimThis study aims to explore midwives’ experiences of discussing maternal and childhood immunisation with women and their partners and their confidence in answering parent’s questions.MethodsWe conducted 23 semi-structured interviews with registered Australian midwives working in public and private hospital settings, and in private practice.FindingsMidwives find negotiating the requirement to recommend immunisation within a women-centred framework challenging at times. The vast majority of midwives described their education on immunisation as inadequate and workplace issues, such as time pressure, were identified as further barriers to effective communication about immunisation.Discussion/conclusionThe provision of immunisation training within midwifery education and continued professional development is critical. Appropriately resourcing midwives with the necessary infrastructure, education and resources to fully inform parents about immunisation may have a positive impact on vaccine uptake.     

Midwives’ views of traditional birth attendants within formal healthcare in Nigeria

BackgroundDiscourses around the journey to motherhood in many poorly-resourced countries, particularly in the sub-Saharan African region, with no link to death and danger are limited. The custodians of traditional practices – the traditional birth attendants – are often blamed for the high maternal deaths in this region. Conventional institutional and international thinking about traditional birth attendants is that they are dangerous and therefore should no longer be allowed to practice.AimTo explore midwives’ views of traditional birth attendants’ place within formal healthcare settings in Nigeria.MethodsHermeneutic phenomenological and poststructural feminist approaches were used. Seven midwives volunteered for semi-structured individual face to face interviews.FindingsThe responses of the midwives were diverse and conflicting. Some midwives believe that the traditional birth attendants should be banned, arguing that they are responsible for low uptake of hospital-based maternity care by women which in turn leads to an increase in maternal deaths. Contrastingly, other midwives expressed a view that the traditional birth attendants ‘cannot be phased out’ due to their valid contributions, particularly in the rural areas where access to formal maternity care is limited by intractable structural problems.ConclusionPolicy makers need to reconsider the role of traditional birth attendants. This should involve not only their integration into formal healthcare to work alongside formally trained maternity care providers, but also fostering a healthcare atmosphere where respect and recognition of each practitioner’s skill is paramount.     

Predictors of women’s positive childbirth pain experience: Findings from an Icelandic national study

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.