Midwives’ experiences of using the Mindfetalness method when talking with pregnant women about fetal movements

BackgroundInformation given to pregnant women about fetal movements is important in maternity care and decreased fetal movements is associated with fetal growth restriction and stillbirth. The fetal movement pattern is different for every fetus and women perceive different types of movements. Mindfetalness is a self-assessment method for a woman to use to become familiar with her unborn baby’s fetal movement pattern.AimWe aimed to explore midwives’ perceptions about informing pregnant women about fetal movements and their experiences of working with Mindfetalness in their daily work.MethodsA web-questionnaire was distributed to midwives who participated in a randomized controlled trial evaluating Mindfetalness, a method for the observation of fetal movements. In total, 67 maternity clinics in Stockholm, Sweden, were randomized to Mindfetalness or routine care. Of the 144 midwives working in maternity clinics randomized to Mindfetalness, 80% answered the questionnaire.FindingsThe midwives thought that the leaflet about Mindfetalness was supportive in their work when informing women about fetal movements and the majority wanted to continue to distribute the leaflet when the trial ended. The midwives also expressed that the study increased their own knowledge about fetal movements. Women embraced the information about Mindfetalness positively and appreciated the written material. The midwives thought that talking about fetal movements in maternity care is an important but challenging task.ConclusionMindfetalness is a useful tool to use in maternity clinics when informing pregnant women about fetal movements. The written information was appreciated by both pregnant women and midwives.     

The migration map trap. On the invasion arrows in the cartography of migration

ABSTRACT

How is undocumented migration typically mapped in contemporary cartography? To answer this question, we conduct an iconological dissection of what could be seen as the epitome of the cartography on undocumented migration, the map made by Frontex – the EU’s border agency. We find that, rather than a scientific depiction of a migratory phenomenon, its cartography peddles a crude distortion of undocumented migration that smoothly splices into the xenophobic tradition of propaganda cartography – and stands in full confrontation with contemporary geographical scholarship. We conclude with an urgent appeal for more scientifically robust, critical and decidedly more creative cartographies of migration.     

Women's perspective of maternity care in Cambodia

BackgroundConsideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia.MethodsA qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach.FindingsWomen's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour.ConclusionWomen expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period.     

Searching for therapies,seeking for hope: transnational cancer care in Asia

ABSTRACT

This paper is about transnational cancer care in Asia. People with terminal diseases such as cancer increasingly escape devastating prognosis of their local regimes of clinical diagnostic truth by traveling to destinations where medicine is more advanced, yet affordable for them, and hence offers a broader scope for hope. The paper suggests that transnational cancer care provides an instructive case of the enormous geographical disparities in the availability of therapies and how this, combined with economies of hope and the marketization of health care, affects patients and their family caregivers. The primary contribution of the paper is the introduction of the concept of relational subjectivities to the health mobilities literature. The findings presented proof that the concept provides a fruitful analytical lens, yielding not only fresh empirical insights but prompting re-conceptualizations of medical travel itself as hopeful, yet risky transnational acts of family care.     

Some Spatial Politics of Queer-Feminist Research: Personal Reflections From the Field

ABSTRACT

This article addresses methodological issues emerging from research conducted with Trans in the Center, an LGBT activist group in Tel Aviv, Israel. It addresses some complex issues related to the politics and ethics of applying queer and feminist methodology to qualitative research in a trans, queer, and feminist community space. The focus is on two issues: the researcher’s positionality vis-à-vis the participants and selecting the appropriate methodology in relation to the characteristics of the group under study. Such issues demonstrate how queer and feminist principles are articulated and interwoven in geographical-spatial research in two different dimensions: in the research practice and methodology and in the practices and the spaces created by the activity of the researched group itself. I conclude with insights arising from the attempt to apply feminist and queer paradigms in both theory and research, and I call for their integration into geographical research.     

Family involved or left behind in migration? A family-centred perspective towards Estonia-Finland cross-border commuting

ABSTRACT

The aim of this paper is to find out how the active cross-border mobility of one family member changes the communication patterns inside the family and how it impacts those who stay behind. Concentrating on the case study of Estonian men working in Finland, this paper examines how families are maintaining relationships with people close to them and what kind of new practices are created to overcome the geographical distance. The importance of both active real-life and mediated communication, media usage, and social-media practices, but also new travelling practices are stressed. The perspectives of both the mobile members of the family and those who stay behind are covered with a focus on how all family members are involved in the migration processes. The fieldwork demonstrates that the mobility of one member of the family can influence the partner and children to take a more active position in maintaining communication during the period of working abroad. Through media usage and international visits, the partner and children gain a special kind of transnational lifestyle.     

Ecological analysis of adolescent birth rates in Brazil: Association with Human Development Index

BackgroundAdolescent pregnancy is a multidimensional public health problem. It is known that every year in Brazil approximately 1.1 million adolescents become pregnant and around 20% of all newborns are born to teenage mothers.AimThis ecological study describes the spatio-temporal patterns of the percentages of live births to adolescent mothers between the years of 2010 and 2016 in Brazil and their associations with human development indexes in the meso-regions where they reside.MethodsPercentages of live births to adolescent mothers are the ratio between the number of live births to women aged 10–19 years old and total number of live births in each Brazilian meso-regions during the study period. A spatio-temporal Bayesian model was used to associate the percentages of live births to adolescent mothers with the human development index of each meso-region. Moran’s index was used to measure the spatial autocorrelation between the meso-regions at an aggregate level, whereas the local indicator of spatial auto-correlation measured local correlation.FindingsPercentages of live births to adolescent mothers for the whole country were 19.3% in 2010 and 17.5% in 2016. There is a heterogeneous spatial distribution pattern for these percentages, being the highest percentages in the North region (24.8% in 2016) and the lowest percentages in the Southeast region of the country (14.3% in 2016). The Bayesian model showed that meso-regions with lower human development index values have higher percentages of live births to adolescent mothers.ConclusionOur findings suggest that adolescent pregnancy is deeply associated with environmental characteristics.     

Security and Belonging: Reconceptualising Aboriginal Spatial Mobilities in Yamatji Country,Western Australia

Abstract

Since British colonisation of Australia began, Aboriginal mobility practices have been poorly understood within the Anglo‐Australian consciousnesses. This paper examines current discourses and conceptualisations of Aboriginal mobilities in Yamatji country, Western Australia. Finding none of these explanations and interpretations singularly sufficient to encompass the diverse spatial practices of Aboriginal people in the region, the paper proposes an alternative framework for interpreting and understanding these population dynamics. The central tenet of this reconceptualisation is that contemporary Aboriginal spatialities – including spatial distribution, movements, and immobility – are iteratively shaped by the processes of procuring, contesting, and cultivating security and belonging. In a conscious shift away from generalised and pejorative interpretations of Aboriginal mobility, this more holistic framework considers historical and geographical context, cultural identity, and individual aspirations.     

“He's a Big Old Girl!” Negotiation by Gender Inversion in Gay Men's Speech

ABSTRACT

On the basis of participant observation in the gay communities of San Francisco, Paris and Oslo, this article charts a pattern of gender inversion in the negotiation of identities and social relations that can be related to an international gay culture. The use of gender inversion in gay men's speech is seen as evidence of the discursive construction of specific generic identities whose capacity to carry meaning is dependent on conventional categories of gender.     

Age patterns of mortality for older women: An analysis using the age‐specific rate of mortality change with age

The age‐specific rate of mortality change with age, defined by k(x) = d Inμ(x)/dx, where μ(x) is the age‐specific death rate at exact age x, is estimated for middle and old ages in ten selected populations that are considered to have relatively accurate age data. For females in each of the study populations, k(x) follows a bell‐shaped curve that usually peaks around age 75. In some of the populations, the age pattern of k(x) for males is confounded with substantial cohort variations, which seem to reflect long‐term impacts of their World War I experiences.

Among the mathematical models proposed by Gompertz, Makeham, Perks and Beard, only the Perks model is consistent with the bell‐shaped pattern of k(x). It is shown that, if the risk of death for every individual follows the Makeham equation and if the individual frailty is gamma‐distributed, then the age‐specific death rate follows the Perks equation.     

“Overwhelmed and out of my depth”: Responses from early career midwives in the United Kingdom to the Work,Health and Emotional Lives of Midwives study

BackgroundEfforts to resolve the longstanding and growing staffing crisis in midwifery in the United Kingdom have been hampered by very poor retention rates, with early career midwives the most likely to report burnout and intention to leave the profession.AimsTo establish the key, self-described factors of satisfaction and dissatisfaction at work for early career midwives in the United Kingdom, and suggest appropriate and effective retention strategies.MethodsThematic analysis was undertaken on a subset of free text responses from midwives who had been qualified for five years or less, collected as part of the United Kingdom arm of the Work, Health and Emotional Lives of Midwives project.FindingsMidwives described feeling immense pressure caused by an unremittingly heavy workload and poor staffing. Where relationships with colleagues were strong, they were described as a protective factor against stress; conversely, negative working relationships compounded pressures. Despite the challenges, many of the midwives reported taking great pleasure in their work, describing it as a source of pride and self-esteem. Midwives valued being treated as individuals and having some control over their shift pattern and area of work.DiscussionThese results, which reveal the strain on early career midwives, are consistent with the findings of other large studies on midwives’ wellbeing. All available levers should be used to retain and motivate existing staff, and recruit new staff; in the meantime, considerable creativity and effort should be exercised to improve working conditions.ConclusionThis analysis provides a ‘roadmap’ for improving staff wellbeing and potentially retention.     

The experiences of pregnant women during the COVID-19 pandemic in Turkey: A qualitative study

BackgroundDue to spread and impact of COVID-19 in the world and Turkey lead to fear, stress and anxiety in individuals. This trend is increasing more especially in pregnant women at risk as they are concerned about the safety of themselves and the fetus.AimIn our study, concerns, problems and attitudes of pregnant women related to diseases in the pandemic process will be determined by detailed discussions based on their individual experience, and by increasing the awareness of midwives and nurses about what pregnant women experience in this process.MethodsContent analysis is used as qualitative study pattern. Due to the social isolation rules during the coronavirus pandemic, interviews with pregnant women were planned to be held via mobile phone. The study was completed with 15 pregnant women.ResultsAs a result of the content analysis of the interviews, 3 main themes and 11 sub-themes were identified. The identified themes were as following: (1) not understanding the seriousness and fear of the unknown, (2) coronavirus pandemic and disruption of the routine prenatal care (3) disrupted routines and social lives. Each theme was necessarily discussed separately.ConclusionThe results of the study show that coronavirus pandemic has a significant potential for creating anxiety, adversity and fear, which has a negative emotional effect on pregnant people. It will be useful to provide awareness for midwives and nurses not only about the physical health of pregnant women, but also their mental health, and to cooperate with mental health experts if necessary.     

Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: a systematic review and narrative analysis

BackgroundAustralian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations.AimTo determine rates of breastfeeding initiation and maintenance and compare individually collected survey data with existing routinely collected state and national breastfeeding data for Aboriginal women.MethodsCINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10% of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance.FindingsThe initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 78% (95% CI 0.71, 0.84), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding.ConclusionSignificant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies.     

Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study

BackgroundAround-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice.Research questionWhich communication modalities are used, and most frequently, by MGP midwives and clients?MethodsA prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife–client contact were collected 24 h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected.FindingsDetails about 1442 midwife–client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred.ConclusionThe majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.     

The queer periphery: sexual deviancy and the cultural understanding of space

The association of normative sexuality with the geographical center and sexual deviancy with the geographical periphery represents a pattern of thinking that has stayed with us in different guises throughout history. The article traces this pattern and some of its complex ramifications from the ancient Greeks to the present.     

The Finnish and Swedish Migration Dynamics and Transnational Social Spaces

Abstract

This article contributes to debates about the long-term development of migration dynamics. The argument is based on a study of the transnational dynamics of the migration flows between Finland and Sweden. The two countries provide a good case for studying the long-term development of migration patterns, since there has been a full freedom of movement and the migration patterns are well documented. The article argues that the postwar labor migration from Finland to Sweden created a transnational social space that still today facilitates migration between the two countries. Although Finnish citizens dominate the migration flows in both directions, the number of Swedish migrants has steadily increased. This new pattern can be explained by the development of the transnational social space involving an increasing number of mixed families.     

Multiple Migration Flows of Romanians

Abstract

Most studies on international migration examine population movement between a country of origin and a destination. This article aims to show that migrants often change destinations, a less studied pattern of ‘multiple migrations’. This article explores how such migration occurs and analyses the variables accounting for it. Drawing on qualitative fieldwork research amongst Romanian migrants in Portugal, the article concludes that the growth in multiple migrations of Romanian migrants throughout Europe can be explained by a combination of migration policies and social networks, mediated by migrants’ level of education and type of occupation at the destination.     

Mortality modeling: A review

Looking at survival in terms of biological indicators of aging has given rise to various models of mortality, some of which we review here. The most notable models are that of Strehler and Mildvan, which relates the force of mortality to the ability of organisms to compensate for stress, and that of Sacher and Trucco, which describes the role played by homeostatic forces in shaping the age‐specific pattern of mortality. The analysis of longitudinal data in aging studies now incorporates the notions of heterogeneity and frailty, as well as that of changes in the “repair capacity”; of organisms. Furthermore, attention is now being paid to evolutionary theory and to models of senescence. These models and directions for further research are discussed.     

Socio-economic Differentials in Infant and Child Mortality during Mortality Decline: England and Wales, 1890–1911

In this paper data from the 1911 Census of the Fertility of Marriage of England and Wales are used to study patterns of mortality decline by socio-economic characteristics, principally the occupation of husband. That census reported data on number of wives, children ever born, and children dead by marriage-duration cohorts for 190 non-overlapping occupations of husband. These results, along with those on number of rooms in the dwelling of the family are used to make indirect estimates of childhood mortality using the techniques described in United Nations, Manual X. These procedures produce values of q(a), the probability of dying before reaching some exact age ‘a’. Estimates for q(2), q(3), q(5), q(10), q(15), and q(20) are derived from data on women married 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 years, respectively. These estimates can also be dated to a point in the past. These values can also be converted to a corresponding level of a Model West life table, which describes the ‘average’ mortality regime which the children of those women experienced. This furnishes a basis to look at mortality decline for various social classes and occupational groups. Ordinary least squares regressions of the levels of Model West life tables implied by the 1(a) values on time give one measure of mortality decline. Another is the absolute amount of the increase in the level of the Model West life tables from marriage-duration cohort 20–24 years to 0–4 years. The aggregate results indicate that social class in England and Wales during the 1890s and 1900s tended to be related to the speed of mortality decline: childhood mortality declined more rapidly in the higher and more privileged social class groups. But the results were neither nearly as strong nor as regular as those which predicted the level of mortality within any marriage-duration cohort. These outcomes are not particularly sensitive to the three different social-class stratification schemes used: the 1911 English Registrar General's classification; the 1951 English Registrar General's classification; and the 1950 U.S. Census classification. There was also a fairly regular and predictable gradient for the number of rooms in the home: child mortality was higher in families who lived in larger dwellings. Analysis of 190 detailed male occupational groups revealed that considerably more of the variation in mortality levels than of trends could be explained by social-class categories. Between 20 and 40 per cent of variation in mortality trend could be accounted for by social class alone, as opposed to 50 to 80 per cent of mortality levels for different marriage-duration cohorts. Results for a more restricted sample of 116 occupations for which income estimates could be made revealed a similar pattern. In addition, income was virtually unrelated to the pattern of mortality decline, and improvement was more rapid in groups who were more urban. This reflects the role of rapidly improving urban sanitation in the late nineteenth and early twentieth centuries in England. In contrast, income was significantly related to childhood morality levels for various marriage-duration cohorts (with higher income associated with lower mortality), while urbanization was inversely correlated with mortality levels (more urban groups experienced higher mortality). Overall, social class (or occupation group), income, and urbanization were more successful in explaining mortality levels than time trends across occupations, although social class and the extent of urbanization did reasonably well in accounting for trends. Over a longer period, the transition in child mortality was under way by the 1890s, but its pace and timing varied in different occupations and social class groupings. Although absolute differences in infant mortality were reduced after about 1911, relative inequality persisted even as infant and child survival improved for all groups.