Building capacity of maternity staff to discourage the use of sunlight therapy in the post-partum period and infancy

PURPOSE: To describe the development, implementation and evaluation of an educational intervention that addresses risky beliefs held by midwives and nurses working in maternity areas and new mothers about therapeutic sun exposure. PROCEDURE: In 2002-2003, 59 midwives and nurses from a hospital in northern Queensland participated in an educational intervention to discourage mothers from exposing themselves and their infants to sunlight for therapeutic reasons. Intervention staff attended an educational workshop and/or received educational resources. Resources (posters, pamphlets and bookmarks) were developed for the staff to use for educating mothers. Process evaluation of the quality and usefulness of the workshop and resources was conducted immediately after the workshop and 12 months later. FINDINGS: Intervention staff indicated that the workshop was relevant to their work, and increased their knowledge and confidence in talking to mothers about sunlight exposure. Ninety percent of the 59 participants indicated they had used the workshop information in their interactions with post-partum mothers. Of the resources, pamphlets and bookmarks were used most often. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The educational intervention was successful in developing the knowledge of midwives and nurses to provide sound advice to new mothers about therapeutic sun exposure and in developing resources to support them in their education. Although workshops and resources are useful in the short term, they are impractical to sustain. To improve sustainability, content on this topic needs to be incorporated into midwifery and nursing curricula across Australia.     

A phenomenological exploration of parenting after birth trauma: Mothers perceptions of the first year

ProblemWhile perinatal mental health issues are considered to have an impact on a mother’s parenting capacity, there is limited research exploring mothers’ perceptions of their relationship with their child following traumatic birth experiences and how these might affect their parenting capacity.BackgroundBirth trauma is a well-recognised phenomenon which may result in ongoing physical and perinatal mental health difficulties for women. This may impact on their attachment to their children, their parenting capabilities, and their self-identity as mothers.AimsTo explore maternal self-perceptions of bonding with their infants and parenting experiences following birth trauma.MethodsIn-depth interviews with ten mothers were undertaken using an Interpretative Phenomenological Analysis methodology.FindingsWomen who experienced birth trauma often described disconnection to their infants and lacking confidence in their parental decision making. Many perceived themselves as being ‘not good enough’ mothers. For some women the trauma resulted in memory gaps of the immediate post-partum period which they found distressing, or physical recovery was so overwhelming that it impacted their capabilities to parent the way they had imagined they would. Some women developed health anxiety which resulted in an isolating experience of early parenthood.ConclusionsWomen who have suffered birth trauma may be at risk of increased fear and anxiety around their child’s health and their parenting abilities. Some women may experience this as feeling a lower emotional attachment to their infant. Women who experience birth trauma should be offered support during early parenting. Mother-Infant relationships often improve after the first year.     

“Renewed” “Older” Motherhood/Mothering: A Qualitative Exploration

This UK-based qualitative study explored multiparous women’s experiences of being “older” mothers. Respondents were “renewed mothers” who had a child/children relatively early in their reproductive careers and then again after 35 years of age. Key themes arising from the empirical data were: instrumental role of male partners in post-35 mothering, purported “renewal” of self in the face of menopause/diminution of mothering, caring for teenagers and babies/toddlers simultaneously, and subjection to criticisms of “wrong-aged” motherhood. Experiences of “renewed” “older” mothers suggest significant hard work is necessitated both in terms of mothering and presentation of self as an appropriate mother.     

Sri Lankan female domestic workers overseas: mothering their children from a distance

Sri Lanka is one of three countries in Asia, along with the Philippines and Indonesia, where women migrants constitute between 60 and 70% of legal migrants; these female migrants are mainly employed overseas as domestic workers. Since the 1980s, the out-migration of Sri Lankan females for employment abroad surpassed that of males and the major destination has been countries in the Middle East. The majority of these women are married and have at least one child; they leave their children in the care of other family members in their absence. While they usually make arrangements to accommodate the spatial separation forced by migration, their migration poses many challenges to themselves and their children left behind. Recently, the issue of children left behind by migrant mothers has attracted growing attention from policy makers in Sri Lanka. Since the social and emotional ramifications of mothering from a distance and how these mothers cope with them are inadequately investigated, this article uses data collected from a 2008 survey of 400 Sri Lankan female migrant families to examine the effects of mothers’ migration on how they are mothering their children from a distance, and how they perceive the effects on their children. The article concludes with some suggested policy recommendations.     

Good Mothers Never Wane: Mothering at Menopause

ABSTRACT

Due to recent feminist scholarship, we know a considerable amount about women's mothering identities and activities, as well as the impact of mothering ideology on individual women. Nonetheless there are gaps in our knowledge about motherhood. For instance, we know mostly about experiences of mothers with young children, and an implicit assumption is that mothers are also fairly young themselves. Yet, what about mothers at midlife and beyond? What about menopausal mothers? This paper represents an initial attempt to explore motherhood experiences of middle-aged menopausal women. Findings presented in this article are based on 45 in-depth interviews with middle-class, heterosexual menopausal women in a midwestern state in 2001. Findings suggest that motherwork and the maintenance of “good” mothering ideology are still primary activities of women at menopause despite assumptions that menopausal women have completed mothering experiences and are now grandmothers (if caregivers at all). In analyzing menopausal mothers, I encourage broader explorations of women's experiences of both motherhood and menopause.     

Good mothers never wane: mothering at menopause

Due to recent feminist scholarship, we know a considerable amount about women's mothering identities and activities, as well as the impact of mothering ideology on individual women. Nonetheless there are gaps in our knowledge about motherhood. For instance, we know mostly about experiences of mothers with young children, and an implicit assumption is that mothers are also fairly young themselves. Yet, what about mothers at midlife and beyond? What about menopausal mothers? This paper represents an initial attempt to explore motherhood experiences of middle-aged menopausal women. Findings presented in this article are based on 45 in-depth interviews with middle-class, heterosexual menopausal women in a midwestern state in 2001. Findings suggest that motherwork and the maintenance of "good" mothering ideology are still primary activities of women at menopause despite assumptions that menopausal women have completed mothering experiences and are now grandmothers (if caregivers at all). In analyzing menopausal mothers, I encourage broader explorations of women's experiences of both motherhood and menopause.     

Brain death during pregnancy and prolonged corporeal support of the body: A critical discussion

Aim

To discuss corporeal support of the brain-dead pregnant woman and to critically examine important aspects of this complex situation that remain as yet unexplored.

Semantic analysis of natural language processing in a study of nurse mobility in the Northern Territory,Australia

In lieu of diverse consequences in the demand and supply of health care professionals such as nurses and midwives in Australia and the world, a firm understanding of the characteristics of staff mobility and the factors influencing their retention could lead to achieving enhanced service delivery, greater job satisfaction, and the establishment of a more stable and robust workforce. The research reported in this paper attempts to shed light on qualitative aspects of mobility in health care professional staff in the Northern Territory of Australia. It builds upon an existing survey study of the quantitative factors that determine why nurses and midwives come to the Northern Territory, why some stay and why many leave, by analysing additional qualitative textual responses of participants using semantic network approaches to natural language processing. Our results illustrate the methodological and policy significance of semantic approaches to knowledge acquisition and representation, especially in complementing findings of traditional survey analysis techniques, and in analysing the broader social settings, effects and consequences of staff retention and mobility.     

Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa

BackgroundIn American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.Aims(1) To examine American Samoan mothers’ feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.MethodsEighteen semi-structured interviews were conducted with American Samoan mothers at 16–32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.FindingsIntention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous “back-up option” where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.ConclusionThis study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.     

Using epidemiological and health economic measures to inform maternity staffing decisions: A guide

BackgroundThere is growing concern around unnecessary intervention (particularly caesarean section) at birth in high-income countries. Caseload midwifery care aims to offset this, but is perceived to be costly to health services.AimTo use epidemiological and health economic techniques to estimate health outcomes and cost-savings of different levels of equivalent full time (EFT) midwives working in caseload midwifery care.MethodsTwo simulations were conducted — one assuming 10 EFT midwives working in a caseload model, with 35 women per caseload, and one assuming 50 EFT midwives working in a caseload model, with 45 women per caseload. Both were based on a sample of 5000 women. The main model inputs included rates of health outcomes for women (caesarean section, epidural anaesthesia, and episiotomy) and infants (low birthweight and admissions to special care nursery (SCN) or neonatal intensive care unit (NICU)), and the cost savings associated with health outcome avoidance.FindingsThe first simulation estimated 27 fewer caesarean sections, 12 fewer epidurals, 12 fewer episiotomies, 10 fewer low birthweight births, and 23 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$1,874,715. The second simulation estimated 173 fewer caesarean sections, 76 fewer epidurals, 76 fewer episiotomies, 65 fewer low birthweight births, and 150 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$12,051,741.ConclusionThis study provides local-level decision-makers with a decision-tool to calculate the potentially avoidable health outcomes and cost savings associated with implementing caseload midwifery care in their own service.     

The dwelling space of postnatal care

BackgroundThis paper considers the dwelling space of postnatal care, how being-there feels for the woman going through the experience of matrescence. The research takes a hermeneutic approach and draws on philosophical notions from Heidegger. Question: ‘What is the nature of the dwelling space of valued postnatal care?’.MethodsAppropriate ethics approval was gained. Participants were midwives, nurses, women, and other relevant stakeholders. There were 4 focus groups involving 11 participants and 19 individual interviews. Data collection was conducted over a one week period by a team of three researchers. An interview schedule had been organised by the administrator at the Centre. Participants chose whether to come to the centre to be interviewed, or be interviewed in their own homes. Most interviews were an hour. All interviews were tape recorded and transcribed, with the participant's permission. Data was analysed through a hermeneutic process set in the context of related literature.FindingsWhen women are invited into a dwelling space that strengthens them they feel ‘mothered’: being listened to, have their needs anticipated, and are cared for in a loving manner. In such a way they grow confidence. A child health nurse reported the difference such care made to on-going mothering at home.Implications for practiceAll women deserve a dwelling space in their early days of matrescence. Small birthing centres perhaps achieve such care and ambience more easily than large institutional units. Nevertheless, wherever the place, practices need to be enabled that foster the spirit of dwelling.     

‘It's those first few weeks’: Women's views about breastfeeding support in an Australian outer metropolitan region

ObjectiveTo examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria.MethodSequential mixed methods design including paper-based survey and focus group enquiry.FindingWomen who had breastfed their infants (n = 170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to ‘give up’. They described themes of: ‘Women's experience of nurses/midwives’, ‘Expectations versus reality’, ‘Not giving up despite difficulties’, and ‘Breastfeeding support’. Sources of lay support were not universal.ConclusionThe duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.     

Race/Ethnicity/Nativity Differentials and Changes in Cause-Specific Infant Deaths in the Context of Declining Infant Mortality in the U.S.: 1989–2001

Using data from the national linked birth/infant death cohort files, we examined race/ethnicity/nativity disparities and changes in infant mortality due to the five leading causes of infant death between 1989 and 2001. Our results indicate substantial decreases in infant mortality from three causes (congenital anomalies, sudden infant death syndrome, and respiratory distress syndrome) for which specific perinatal health innovations emerged or were expanded. However, for these three causes, the relative disparities in infant mortality between infants born to U.S.-born black women as compared to infants of U.S.-born white women increased following the introduction (or expansion) of beneficial interventions. Among infants of U.S.-born Mexican American mothers, the findings differed. In the static comparisons, our results show the often-reported similarity in the risk of death of these babies compared to those born to non-Hispanic white mothers. However, when changes over time were modeled, there was an erosion of the relatively favorable survival chances of Mexican American infants. Our models show little change in the relative risk of death for infants of immigrant women. Regarding the other two causes (disorders relating to short gestation and unspecified low birth weight and maternal complications) for which no efficacious innovations occurred, either little change or actual increases in risks were observed. Future studies and health policy efforts should be geared toward further understanding and aggressively working to close infant mortality gaps, especially for infants of U.S.-born black mothers—an effort that will be facilitated by research focused on cause-specific infant mortality.     

What are the views of midwives in relation to perineal repair?

PURPOSE: To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill. PROCEDURE: A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends. FINDINGS: One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time. PRINCIPLE CONCLUSION: A desire to provide continuity of care appears to be a major motivator for midwives to learn to undertake perineal repair. There is need for standards to be set for perineal repair to encourage consistency in education. Perineal repair programs that involve midwives and doctors training together have strong support from midwives but it is unclear if doctors would also support this. Further research is needed to support or refute the trend for midwives to not suture some perineal trauma.     

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BackgroundThe percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.AimTo explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.MethodAn integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.FindingsFive themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.ConclusionIndian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.     

Paradox Revisited: A Further Investigation of Racial/Ethnic Differences in Infant Mortality by Maternal Age

I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995–2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.     

The politics of midwifery education and training in New South Wales during the last decades of the 19th Century

This paper focuses on the introduction and development of midwifery education and training in Sydney during the last decades of the 19th century. The aim of the training, it is argued, was to displace the lay midwives by trained midwifery nurses who would work under medical control. The lay midwives were one of the largest occupational groups among women and two-thirds of births in NSW were being delivered by them in the late 19th century. It was a period of professionalisation of medicine and medical men laid claim to midwifery as a legitimate sphere of their practice and saw it as the gateway for establishing a family practice. The lay midwife stood in the way of their claim. The training programs were established purportedly to control maternal mortality. From the beginning in 1887 medical men were in control of midwifery nurse training. In addition to training at the Benevolent Society Asylum, three more women's hospitals were established in the 1890s in Sydney making it possible to train a stream of midwifery nurses. The midwifery nurses were charged exorbitant fees for their training; the fees contributed substantially towards running the new hospitals that delivered birth services to the poor and destitute women mostly in their homes. The midwifery nurses worked hard in miserable conditions under the guise of clinical experience required for training. When a critical mass of poorly trained midwifery nurses were in the offing, a Bill was introduced into the Parliament in 1895, restricting registration to midwifery nurses and this would have eliminated the lay midwife if passed. It took more than two decades to get a Registration Bill passed in the NSW Parliament.