The grandmother role as experienced by lesbian women

This study explores the grandmother role as experienced by a nonrandom sample of nine lesbian women. It examines how they define the grandmother role, and the behaviors and actions through which they enact the role. During individual interviews each woman was asked to talk about what makes a woman a good grandmother, memories of her own grandmothers, and the relationship she has with one or more of her grandchildren. The effect of her sexual orientation on the relationship was not explored. These women define the grandmother role as providing emotional support to their grandchildren, providing varied experiences for their grandchildren, and providing support for the parents of their grandchildren.     

Inside stories: Maternal representations of first time mothers from pre-pregnancy to early pregnancy

BackgroundAccording to the psychoanalytical literature, it is during pregnancy that maternal representations of the mother–infant relationship become activated. Midwives who are engaged with the mother and the baby have not drawn upon this concept in their practice. In order for this to happen, it is important to understand better the nature of maternal representations and when they are activated from empirical studies.QuestionThe research question is: what are the maternal representations of a group of first time mothers from pre-pregnancy, early pregnancy and to the first ultrasound.MethodA narrative approach was used to gain insight into the maternal representations of first time pregnant womens’ account of their representations. The analysis method was based on thematic approach.ParticipantsFifteen women aged between 23 and 38 years.SettingA midwives clinic attached to a tertiary hospital in Melbourne, Australia.FindingsFirst-time pregnant women's maternal representations were activated when a woman begins to plan her pregnancy (‘the time is right’), again at the onset of physical changes to her body as a result of conception (‘my body is changing’), and at the first early ultrasound at around twelve weeks (‘it’ is a real baby).ConclusionMaternal representations are important for the midwife and pregnant women because this concept provides another understanding in relation to the psychological dimension of pregnancy.     

The Guardianship Experience of Women: The Relationship Between Older Wards and Their Guardians

SUMMARY

This research examined how 156 female legal caregivers responded to difficulties of being a guardian, how they derived meaning from their guardianship activities, and how the role of guardian influenced their perception of aging. The most frequent activities in which guardians engaged were visiting, providing emotional support, and to a lesser extent, giving instrumental assistance. Guardians described their emotional relationships with their wards as either “sympathetic,” “sad,” “challenged,” or “hostile.” Despite hardships associated with the duties of being a guardian, most of the women perceived benefits and expressed satisfaction from this role. Guardians reported that the relationship with their female wards shaped their perception of aging and the conception of their own aging.     

Older Women,Their Children,and Grandchildren: A Feminist Perspective on Family Relationships

SUMMARY

Using gerontological and feminist frameworks, we explored the relationships older women have with their children and grandchildren. In-depth, qualitative interviews were conducted with 34 women, ranging in age from 55 to 88. From our analyses of the women's perceptions of their family relationships, two themes were prevalent: the centrality of children and the peripherality of grandchildren in their everyday lives. The women had varying degrees of involvement with their children and grandchildren, and these relationships contributed to their sense of self and family. Their relationships were not stagnant, but were continually reshaped as both the women and their family members proceeded through the life course.     

Midwifery Job Autonomy in New Zealand: I do it all the time

IntroductionThis research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand.MethodsRegistered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically.FindingsThe participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously ‘all the time’. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman – regardless of the midwife’s work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives’ autonomy while a negative hospital work culture could hinder job autonomy.DiscussionMidwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy.ConclusionThe high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.     

Milk siblingship,religious and secular: History,applications, and implications for practice

Problem or backgroundMilk kinship has religious and practical importance to Muslim families that is not well understood in Western cultures. The relationship occurs when an infant receives the milk of a woman other than the biological mother, creating familial relationships between the child and the woman whose milk is received. As milk siblings, her children and the recipient infant must never marry each other. Midwives in Western countries may encounter this in relation to human milk banking.AimThis review provides a context for respectfully assisting families with their decision making when they are offered banked milk.MethodsA database search was conducted and other publications were found manually.Review/findingsMilk siblingship can be religious or secular. In Islam similar prohibitions on marriage exist to those for blood relations. The mothers therefore have to be known to each other to prevent an inappropriate marriage. This relationship has been a barrier to use of human milk banks by Muslim families as milk from several mothers is usually pooled. Nevertheless, donor milk has been used for premature neonates in two Islamic countries, applying the religious requirements. Recent interpretations by some Islamic scholars permitting milk banking may be acceptable to some families, but others will heed other rulings.Conclusion/implicationsNICU staff may encounter difficulties in providing banked human milk to infants from Muslim families. Different rulings exist and Muslim families in Western countries come from a variety of traditions. Sensitivity is required to explore these issues with families.     

Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives

BackgroundHealth inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman’s vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care.AimTo explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand.MethodInductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care.FindingsA total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings.ConclusionMidwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.     

A selective review of prenatal exercise guidelines since the 1950s until present: Written for women,health care professionals,and female athletes

BackgroundTraditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950s.AimThe goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus.DiscussionPregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise.ConclusionResearch is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant.     

Placenta praevia,placental abruption and amphetamine use in pregnancy: A case study

Pregnant women who misuse alcohol or substances often develop obstetric conditions that further complicate their pregnancy. This case study reflects on the maternity care provided for a woman who continued to use amphetamines during her pregnancy; and who was diagnosed with placenta praevia and subsequently suffered a placental abruption. Alcohol and substance misuse in pregnancy is currently escalating, increasing the risk in maternal and neonatal morbidity and mortality. Midwives must be confident in the advice and care they provide in order to reduce the risks caused by substance misuse, and be able to support this with evidence-based care.PurposeThe purpose of this case study is to discuss the obstetric condition involved with placenta praevia with the occurrence of a placental abruption in a woman who uses amphetamines during pregnancy; and the midwifery and obstetric care involved.Interest/relevance/congruencyIt will highlight the importance of evidence-based care in high risk obstetrics.Content(1) Case summary; (2) discussion; (3) risk factors; screening, diagnosis and management; foetal and neonatal monitoring; postnatal management, and trauma informed care.ConclusionIt was shown with planning, understanding, communication, and vigilance, the care of an amphetamine using pregnant woman with a diagnosis of placenta praevia and abruption can be successfully accomplished. The management of the woman discussed in this case study was within the recommendations currently available in the literature.     

The experience of giving birth with epidural analgesia

Problem and backgroundThere is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used.QuestionHow do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need?MethodsA field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth.FindingsInitiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence.Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance.ConclusionAfter initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries.     

‘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.     

Salutogenic qualities of midwifery care: A best-fit framework synthesis

BackgroundAlthough midwifery care is wellness-based and promotes normal physiology, it exists within a medical model that focuses on risk aversion and disease prevention. Salutogenic theory could provide an alternative approach to midwifery care, supporting health-promoting factors, rather than solely avoiding adverse events.AimsThe aim of this study was to explore women’s experiences of their midwifery care and identify salutogenic aspects of midwifery care.MethodsBest-fit framework synthesis was used to analyse 349 quotes about women’s experiences of midwifery care from 31 qualitative studies in ten high-income countries. Key salutogenic concepts of comprehensibility, manageability and meaningfulness were used as the basis for coding, and thematic analysis was used to expand and clarify the framework to best fit the data.FindingsDefinitions for the salutogenic aspects of midwifery care were developed. Comprehensibility (cognitive aspects of health): ways that midwives help women increase predictability and preparation during childbearing through apredictable caregiver, a predictable system and preparation for an unpredictable experience. Manageability (behavioural aspects of health): ways that midwives enhance and support a woman’s internal resilience, adding extra support when needed, and strengthen women’s external resources through connections to family, community and specialist care. Meaningfulness (emotional/spiritual aspects of health): ways that midwives encourage the commitment and engagement of childbearing women by providing care through a personalised relationship, by cultivating a woman’s autonomy.ConclusionFindings of this study may be used to further research into ways that salutogenic theory can bring a health and wellness-focused agenda to midwifery policy and practice.     

Supporting women to achieve breastfeeding to six months postpartum – The theoretical foundations of a successful program

BackgroundAlthough the benefits of breastfeeding to six months are well-established, only about half of Australian women succeed. The factors associated with successful breastfeeding are rarely translated into effective interventions. A new educational and support program, called the Milky Way program has been demonstrated to be effective in supporting women to achieve prolonged breastfeeding. In the Milky Way program, breastfeeding is considered an embodied performance which requires an engaged combination of body, mind and spirit. This paper aims to explain how the two theories that informed the program were used to better enable women's long term breastfeeding success.MethodThe theory of self-efficacy is first described as a way to develop women's cognitive processes to organise and execute the course of actions to breastfeed for a longer period of time. Birth territory theory is then presented. This theory discusses women as embodied selves; an essential concept for breastfeeding success. Birth territory theory also describes the effects of the holistic environment on the woman and explores the effects of power that is used in the environment. This power can be used integratively to strengthen the woman's breastfeeding confidence and success or, disintergratively which reduces her confidence and undermines her success.ConclusionStrategies based on self-efficacy theory are helpful, but are not sufficient to promote breastfeeding to six months. Health educators also need to foster the woman's connection to, and trust in, her body and her baby's body to breastfeed spontaneously. Being aware of environmental impacts on how the woman and baby breastfeed; and using one's own power integratively is crucial to women being able to achieve prolonged breastfeeding.     

The role of support person for Ngaanyatjarra women during pregnancy and birth

BackgroundThis study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaanyatjarra women's cultural practices have been subject to erosion during the past 70 years. Women are now expected to birth hundreds of kilometres from home and, due to financial barriers, without family support. Older women lament their lack of input into, and control of, contemporary birthing services.Research questionIn order to provide culturally appropriate maternity services we asked: What issues would the Ngaanyatjarra women of the community like to see resolved in the area of antenatal and birthing services?Participants and methodsEligible participants were any Ngaanyatjarra women of the study community who had birthed at least once. We utilised a participatory research methodology. 36 women were interviewed.FindingsThis paper discusses one finding related to support for child-bearing women. The role is important in many ways. Ngaanyatjarra women did not traditionally have their support persons with them during labour and birth, nor do they necessarily expect them to be present in current times. Most women do, however, wish to have a support person with them during antenatal checkups and when they travel to town to await birth.ConclusionAboriginal women from remote communities should be able to have a support person with them when they access regional birthing services, but the nature of this role must not be assumed. A culturally appropriate service has input from the community, provides options and respects choices.