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Dişsiz M, Bayrı Bingöl F, Demirgöz Bal M, Karaçam Yılmaz ZD, Karakoç A, Bilgin Z. The Turkish version of the Postpartum Bonding Questionnaire (PBQ): Examination of the validity and reliability and scale structure. J Pediatr Nurs 2024; 77:131-139. [PMID: 38518689 DOI: 10.1016/j.pedn.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The aim of this study is to investigate the validity and reliability of the Turkish version of the Postpartum Bonding Questionnaire (PBQ). DESIGN AND METHODS This methodological study was conducted with 250 women who presented to three family health centers in Istanbul/Turkey between April and June 2022 and met the sampling criteria. Validity analysis was performed using the content validity index, exploratory factor analysis, and confirmatory factor analysis. Pearson product-moment correlation and Cronbach Alpha reliability coefficients were used for reliability analysis. RESULTS To evaluate invariance of the instrument over time, test-retest measurements were conducted at least two weeks apart and showed no difference in mean scores (p > .05). Adjusted goodness-of-fit index >0.97 and comparative fit index >0.98 confirmed the construct validity of the Turkish PBQ. Each item had a content validity index of 96%. Corrected item-total score correlations ranged from 0.50 to 0.93. The Cronbach Alpha was found to be 0.96, indicating high internal consistency. CONCLUSION The results of this study show that the Turkish version of the PBQ is valid and reliable. It can be used as a measurement tool to determine the degree of maternal bonding in the postpartum period.
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Affiliation(s)
- Melike Dişsiz
- Health Science University, Hamidiye Faculty of Nursing, Department of Obstetrics and Gynecologic Nursing, Uskudar, Istanbul, Türkiye.
| | - Fadime Bayrı Bingöl
- Marmara University Faculty of Health Sciences Department of Midwife, Maltepe, Istanbul, Türkiye
| | - Meltem Demirgöz Bal
- Marmara University Faculty of Health Sciences Department of Midwife, Maltepe, Istanbul, Türkiye
| | | | - Ayşe Karakoç
- Marmara University Faculty of Health Sciences Department of Midwife, Maltepe, Istanbul, Türkiye
| | - Zümrüt Bilgin
- Marmara University Faculty of Health Sciences Department of Midwife, Maltepe, Istanbul, Türkiye
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Thomson G, Balaam MC, Tishkovskaya S. Comparing factors associated with overall satisfaction for different forms of remote breastfeeding support in the UK. Int Breastfeed J 2024; 19:36. [PMID: 38778298 PMCID: PMC11112964 DOI: 10.1186/s13006-024-00641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Remote forms of breastfeeding support, such as helplines and social media, offer a flexible and convenient form of support to offer help at critical points, e.g., when the risk of breastfeeding cessation is high. Currently, there is little known about who accesses different forms of remote breastfeeding support and what factors impact overall satisfaction. As part of an evaluation of the UK National Breastfeeding Helpline (NBH) (which offers breastfeeding support via a helpline and online media), we aimed to (a) understand who accesses different forms of NBH support, and (b) identify key factors associated with overall satisfaction for helpline and online media support. METHODS All service users who contacted the NBH between November 2021 and March 2022 were invited to participate in the evaluation via an online survey. Survey questions explored the type and timing of support, reasons for the contact, attitudes towards the help and support received, impact of the support on breastfeeding experiences and demographic factors. Chi-squared and Mann-Whitney tests explored variations in who accessed the helpline or online media. Multiple linear regression models were fitted to explore the factors related to the service users' 'overall satisfaction'. The quantitive data were combined with qualitative comments into descriptive themes. RESULTS Overall, online media users were significantly more likely to be younger, White, multiparous, less educated and have English as a first language compared to those who contact the helpline. Similar factors that significantly influenced overall satisfaction for both support models were the service being easy to access, receiving helpful information that met expectations, resolving breastfeeding issues, and feeling reassured and more confident. Significant factors for the helpline were callers feeling understood and more knowledgeable about breastfeeding following the call, being able to put into practice the information provided, feeling encouraged to continue breastfeeding, feeling that the volunteer gave the support that was needed, and seeking out additional support. CONCLUSIONS Online and helpline forms of breastfeeding support suit different demographics and call purposes. While optimal breastfeeding support needs to be accessible, flexible and instrumental, helpline users need real-time relational support to deal with more complex challenges.
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Affiliation(s)
- Gill Thomson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK.
| | - Marie-Clare Balaam
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Svetlana Tishkovskaya
- Health Statistics Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
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Deliktas Demirci A, Oruc M, Kabukcuoglu K. "I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing. Midwifery 2024; 131:103955. [PMID: 38368848 DOI: 10.1016/j.midw.2024.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice. AIM To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented. METHOD A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews. RESULTS Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period. CONCLUSION The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.
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Affiliation(s)
- Ayse Deliktas Demirci
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Dumlupınar Bulvarı, Antalya 07058, Turkey.
| | - Mine Oruc
- Antalya Science University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey
| | - Kamile Kabukcuoglu
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Dumlupınar Bulvarı, Antalya 07058, Turkey
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Weidner K, Bartmann C, Leinweber J. [Traumatic childbirth and trauma-sensitive obstetric support]. DER NERVENARZT 2023; 94:811-820. [PMID: 37351670 DOI: 10.1007/s00115-023-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
Childbirth can be a very happy and empowering experience for women but also one of suffering and despair. Biographical traumatic experiences, especially sexual, physical and emotional violence, are risk factors for a traumatic childbirth experience with the danger of subsequent trauma sequelae and impaired mother-child bonding; however, obstetrically indicated interventions or poor communication in the delivery room can also primarily be experienced as traumatic.In recent years, policies affecting traumatic childbirth experience have been controversially and sometimes emotionally discussed. In the clinical obstetric routine there is often a fine line between medically necessary rapid interventions and emotionally supportive trauma-sensitive and preventive obstetric care. The following article addresses the causes and prevention strategies of traumatic childbirth experiences from obstetric, midwifery and psychotherapeutic perspectives.
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Affiliation(s)
- Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Catharina Bartmann
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Deutschland
| | - Julia Leinweber
- Institut für Hebammenwissenschaft, Charité Universitätsmedizin Berlin, Virchowweg 23, 10117, Berlin, Deutschland
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Pidd D, Newton M, Wilson I, East C. Optimising maternity care for a subsequent pregnancy after a psychologically traumatic birth: A scoping review. Women Birth 2023; 36:e471-e480. [PMID: 37024378 DOI: 10.1016/j.wombi.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Psychological birth trauma is recognised as a significant and ubiquitous sequelae from childbirth, with the incidence reported as up to 44%. In a subsequent pregnancy, women have reported a range of psychological distress symptoms from anxiety, panic attacks, depression, sleep difficulties and suicidal thoughts. AIM To summarise evidence on optimising a positive pregnancy and birth experience for a subsequent pregnancy following a psychologically traumatic pregnancy and identify research gaps. METHODS This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR check list. Six databases were searched using key words relating to psychological birth trauma and subsequent pregnancy. Utilising agreed criteria, relevant papers were identified, and data were extracted and synthesised. RESULTS A total of 22 papers met the inclusion criteria for this review. All papers addressed different aspects of what was important to women in this cohort, summarised as women wanting to be at the centre of their care. Pathways of care were diverse ranging from free birth to elective caesarean. There was no systematic process for identifying a previously traumatic birth experience and no education to enable clinicians to understand the importance of this. CONCLUSION For women who have experienced a previous psychologically traumatic birth, being at the centre of their care, in their subsequent pregnancy, is a priority. Embedding woman-centred pathways of care for women with this experience, as well as multidisciplinary education on the recognition and prevention of birth trauma, should be a research priority.
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Affiliation(s)
- Deborah Pidd
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia.
| | - Michelle Newton
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia
| | - Ingrid Wilson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Singapore Institute of Technology, Singapore
| | - Christine East
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
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Monis M, O'Connell R, Andrews T. 'It will dictate how many children I will have"- Women's decision-making in pregnancy following a previous caesarean birth (CB). Midwifery 2023; 116:103533. [PMID: 36347147 DOI: 10.1016/j.midw.2022.103533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/17/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]
Abstract
Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC. AIM To develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women's birth choice and their decision making for birth following a previous CB. DESIGN Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital. FINDINGS The theory of 'Mentalizing Possibilities' is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of 'Mentalizing Possibilities' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process. CONCLUSION Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.
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Thomson G, Cook J, Crossland N, Balaam MC, Byrom A, Jassat R, Gerrard S. Minoritised ethnic women's experiences of inequities and discrimination in maternity services in North-West England: a mixed-methods study. BMC Pregnancy Childbirth 2022; 22:958. [PMID: 36550440 PMCID: PMC9773462 DOI: 10.1186/s12884-022-05279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Minoritised ethnic perinatal women can experience judgemental and stigmatising care due to systemic racism. Discriminatory care contributes to increased risks of poor maternal and infant outcomes, including higher rates of mental ill-health. This study aimed to explore minoritised ethnic women's experiences of maternity services, including maternity care and mental health support, within a North-West England locality. Here we use an equity lens to report the findings that describe if and how women's personal, cultural, and spiritual needs were met, their experiences of discriminatory and prejudicial care, and to identify recommendations for service provision. METHODS A mixed-methods study was undertaken comprising an online survey, interviews, and community consultations. Questions explored access to and experiences of antenatal care and education; information, communication, and choice; experiences of (dis)respect and judgement; mental health needs and support; cultural/religious needs and support; and overall experiences of maternity care. Eligibility criteria were: women, 18+ years, from self-reported minoritised ethnic backgrounds, who had given birth in the previous 2 years and received maternity care in the locality. Surveys were available in seven languages and distributed via social media, mother-baby groups, and community locations. English-speaking survey participants were invited to take part in a follow-up interview. Community staff were approached to collect data on behalf of the study team. Quantitative data were analysed descriptively (n, %) and merged with qualitative data into descriptive themes. RESULTS Overall, 104 women provided data; most self-identified as Asian (65.0%) or Black (10.7%) and were aged between 30-34 (32.0%) or 25-29 years (23.3%). Four descriptive themes are reported: 'accessing care' details variations and barriers in accessing maternity care; 'communication needs, and resources' describes views on adaptions and resources for specific communication needs; 'meeting religious and cultural needs' outlines how various religious and cultural needs were met by maternity providers; 'discriminatory or stigmatising care' reports on experiences of pejorative and inequitable care. CONCLUSIONS An equity lens helped identify areas of discriminatory and inequitable care. Key recommendations include cultural safety training for staff; service-user engagement and co-production of research and resources, and appropriate facilities and recording systems to facilitate individualised, needs-based maternity care.
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Affiliation(s)
- Gill Thomson
- grid.7943.90000 0001 2167 3843School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Julie Cook
- grid.7943.90000 0001 2167 3843Applied Health Research Hub, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Nicola Crossland
- grid.7943.90000 0001 2167 3843School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Marie-Clare Balaam
- grid.7943.90000 0001 2167 3843School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Anna Byrom
- grid.7943.90000 0001 2167 3843School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Raeesa Jassat
- grid.7943.90000 0001 2167 3843School of Medicine, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
| | - Sabina Gerrard
- grid.7943.90000 0001 2167 3843School of Nursing, University of Central Lancashire, Preston, Lancashire PR1 2H2 UK
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Sjömark J, Svanberg AS, Larsson M, Viirman F, Poromaa IS, Skalkidou A, Jonsson M, Parling T. Effect of internet-based cognitive behaviour therapy among women with negative birth experiences on mental health and quality of life - a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:835. [DOI: 10.1186/s12884-022-05168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Giving birth is often a positive experience, but 7–44% have negative experiences and about 4% develop posttraumatic stress disorder following childbirth (PTSD FC). This randomized controlled trial (RCT) investigated the effect of internet-based cognitive behaviour therapy (iCBT) for women with negative birth experiences and/or at risk for PTSD FC.
Methods
This was a superiority nonblinded multicentre RCT comparing iCBT combined with treatment as usual (TAU) with TAU only. Data were collected through questionnaires at baseline, at 6 weeks, 14 weeks and 1 year after randomization. The RCT was conducted at four delivery clinics in Sweden and participants were recruited from September 2013 until March 2018. Women who rated their childbirth experience as negative on a Likert scale, and/or had an immediate caesarean section or a haemorrhage of > 2000 ml were eligible. Primary outcomes were symptoms of posttraumatic stress (Traumatic Event Scale, TES) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Secondary outcomes were satisfaction with life (Satisfaction With Life Scale, SWLS) and coping (Ways of Coping Questionnaire, WCQ).
Results
Out of 1810 eligible women, 266 women were randomised to iCBT+TAU (n = 132) or to TAU (n = 134). In the iCBT+TAU group 59 (45%) completed the treatment. ICBT+TAU did not reduce PTSD FC at 6 weeks, at 14 weeks, or at 1 year follow-up compared with TAU, according to the TES. Both the ITT and completer analyses showed significant time and quadratic time effects due to reduction of symptoms in both groups on the TES (re-experience subscale) and on the EPDS, and significant time effect on the self-controlling subscale of the WCQ (which increased over time). There was also a significant main effect of group on the SWLS where the TAU group showed higher initial satisfaction with life. Exploratory subgroup analyses (negative birth experience, immediate caesarean section, or severe haemorrhage) showed significant time effects among participants with negative birth experience on re-experience, arousal symptoms and depressive symptoms.
Conclusions
The ICBT intervention did not show superiority as both groups showed similar beneficial trajectories on several outcomes up to 1 year follow-up. This intervention for women with negative birth experiences and/or at risk for PTSD FC was feasible; however, the study suffered from significant drop out rate. Future studies with more narrow inclusion criteria and possibly a modified intervention are warranted.
Trial registration
ISRCTN39318241. Date for registration 12/01/2017.
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Heys S, Downe S, McKeown M, Thomson G. The design, delivery and evaluation of 'Human Perspectives VR': An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD. PLoS One 2022; 17:e0276263. [PMID: 36322586 PMCID: PMC9629609 DOI: 10.1371/journal.pone.0276263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. AIMS To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. METHODS A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. FINDINGS Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. CONCLUSION While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.
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Affiliation(s)
- Stephanie Heys
- Maternity Learning and Development Lead, Consultant Midwife, The Northwest Ambulance Service, The University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Soo Downe
- Professor of Midwifery Studies, The University of Central Lancashire, Preston, United Kingdom
| | - Mick McKeown
- Professor of Democratic Mental Health, The University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Professor of Perinatal Health, The University of Central Lancashire, Preston, United Kingdom
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Heys S, Rhind S, Tunn J, Shethwood K, Henry J. An exploration of maternity and newborn exposure, training and education among staff working within the North West Ambulance Service. Br Paramed J 2022; 7:50-57. [PMID: 36447999 PMCID: PMC9662155 DOI: 10.29045/14784726.2022.09.7.2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
AIM Providing emergency and urgent care to pregnant patients and newborns in the pre-hospital setting often presents some of the most challenging and complex incidents attended to by ambulance staff. A service evaluation survey was undertaken to explore current levels of maternity and newborn education, preferred methods of training delivery, exposure and perceived support surrounding maternity and newborn care provision among pre-hospital clinicians working within the North West Ambulance Service (NWAS) NHS Trust. METHODS An online, anonymised survey compromising of 22 questions using multiple choice options and free-text questions was circulated among NWAS staff between 27 May 2021 and 21 June 2021. Questions explored the levels of training, education, exposure and confidence relating to maternal and newborn care in the pre-hospital setting. Insights into preferred approaches to engaging with continuing professional development (CPD) activities were also captured. Data were analysed using built-in Microsoft Forms analytics for quantitative response, with a basic thematic analysis undertaken to synthesise qualitative responses. RESULTS The survey received 509 responses, with data providing valuable insight relating to gaps in training provision, preferred approaches to CPD and barriers to engagement. Key themes focused on 'pre-registration standards and variations', 'barriers and facilitators to continuing professional development' and 'exposure and skill decline: confidence and knowledge'. CONCLUSION Areas for service improvement are highlighted, providing ambulance trusts and integrated care systems with key recommendations. These include maternity and newborn standards for education among paramedic science degree programmes; recognition of pre-hospital emergency maternity and newborn care among maternity providers; the need for exposure and regular multidisciplinary team (MDT) skills training for staff; and a collaborative system-led approach to scaling up and delivering MDT training that acknowledges pre-hospital clinicians as key care providers.
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Affiliation(s)
- Stephanie Heys
- North West Ambulance Service NHS Trust; University of Central Lancashire
| | | | | | - Kate Shethwood
- North West Ambulance Service NHS Trust; Health Education England
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Thomson G, Diop MQ, Stuijfzand S, Horsch A. Policy, service, and training provision for women following a traumatic birth: an international knowledge mapping exercise. BMC Health Serv Res 2021; 21:1206. [PMID: 34742293 PMCID: PMC8571982 DOI: 10.1186/s12913-021-07238-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background High numbers of women experience a traumatic birth, which can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) onset, and negative and pervasive impacts for women, infants, and families. Policies, suitable service provision, and training are needed to identify and treat psychological morbidity following a traumatic birth experience, but currently there is little insight into whether and what is provided in different contexts. The aim of this knowledge mapping exercise was to map policy, service and training provision for women following a traumatic birth experience in different European countries. Methods A survey was distributed as part of the COST Action “Perinatal mental health and birth-related trauma: Maximizing best practice and optimal outcomes”. Questions were designed to capture country level data; care provision (i.e., national policies or guidelines for the screening, treatment and/or prevention of a traumatic birth, service provision), and nationally mandated pre-registration and post-registration training for maternity professionals. Results Eighteen countries participated. Only one country (the Netherlands) had national policies regarding the screening, treatment, and prevention of a traumatic birth experience/CB-PTSD. Service provision was provided formally in six countries (33%), and informally in the majority (78%). In almost all countries (89%), women could be referred to specialist perinatal or mental health services. Services tended to be provided by midwives, although some multidisciplinary practice was apparent. Seven (39%) of the countries offered ‘a few hours’ professional/pre-registration training, but none offered nationally mandated post-registration training. Conclusions A traumatic birth experience is a key public health concern. Evidence highlights important gaps regarding formalized care provision and training for care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07238-x.
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Affiliation(s)
- Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK.
| | - Magali Quillet Diop
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Roberts NJ, Jomeen J, Thomson G. Women's Experiences of the Coping With Birth Trauma:A Psychoeducational Group Support Program. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVEBetween 20%-50% of women experience birth as traumatic, with negative impacts for women, infants and families. Currently, there is a lack of evidence into supportive interventions to ameliorate women's adverse responses following a traumatic birth. In North-West UK, a 6-week psychoeducation group support program (Coping with Birth Trauma [CwBT]) was developed and delivered by two trained therapists. The course aimed to facilitate women's understanding of trauma, and to provide coping strategies; additional speakers were also invited to discuss specialist issues. The aim of this evaluation was to explore women's experiences and perceptions of the CwBT, and to identify recommendations for course development.METHODSFollowing university ethics approval, all the women who had attended a CwBT course (n = 3) were invited to take part in a telephone interview. Eight women out of a possible sample of 16 agreed to participate. Thematic analysis was used to analyse the interview data.RESULTSTwo themes and associated sub-themes describe the social, cognitive and instrumentalcomponents of the CwBT course (“Creating a difference”) and how the course facilitated growth and help-seeking behaviors (“Growth and renewal”). The final theme “complaints and recommendations” details critical reflections and suggestions for course development. Recommendations included speakers from different therapeutic backgrounds and more opportunities for contact with women at different stages of their trauma journey.CONCLUSIONSOverall, the course was well received with positive implications for health, wellbeing and family functioning. Further and large-scale studies to assess its effectiveness are needed.
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Ely S, Langer S, Dietz HP. Informed consent and birth preparedness/complication readiness: A qualitative study at two tertiary maternity units. Aust N Z J Obstet Gynaecol 2021; 62:47-54. [PMID: 34455584 DOI: 10.1111/ajo.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 07/24/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Informed consent in obstetrics should involve full disclosure of risks, benefits and alternative interventions. However, we have found no evidence of a formal informed consent process before an attempt at vaginal delivery in published policy or practice. The idea of informed consent in vaginal birth has attracted controversy and has been the subject of some debate. AIM To explore the perspectives and experiences of informed consent and birth preparedness/complication readiness for birthing women in a high resource setting. MATERIALS AND METHODS Qualitative study using semi-structured interviews to examine experiences and perspectives of women following birth. RESULTS Forty telephone interviews were concluded. Eight statement categories were identified: (i) no issues of consent, (ii) absent/inadequate informed consent, (iii) adequate birth preparedness/complication readiness, (iv) inadequate birth preparedness/complication readiness, (v) desire to forfeit decision making to a trusted and accountable health professional, (vi) belief that informed consent is not realistic in birth under some circumstances, (vii) negative feelings related to birth and (viii) poor postnatal follow-up. CONCLUSIONS When complications arose during birth, 20% of participants felt that informed consent was absent/inadequate, 25% of participants suggested policy change in favour of a formal informed consent process and 55% of participants suggested policy change in favour of increased birth preparedness/complication readiness. Our study suggests that informed consent for vaginal birth and formal birth preparedness/complication readiness should form part of routine antenatal care. Women's preferences for decision-making and informed consent should be established before birth.
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Affiliation(s)
- Sally Ely
- Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Susanne Langer
- Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
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Webb R, Ayers S, Bogaerts A, Jeličić L, Pawlicka P, Van Haeken S, Uddin N, Xuereb RB, Kolesnikova N. When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences. BMC Pregnancy Childbirth 2021; 21:475. [PMID: 34215219 PMCID: PMC8252193 DOI: 10.1186/s12884-021-03898-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Pregnancy and childbirth are significant events in women’s lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants. Method Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions. Results Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life. Conclusions A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women’s expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women’s needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care. Trial registration Protocol registration: PROSPERO CRD42020191081. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03898-z.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, City, University of London, London, EC1V 0HB, UK.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London, EC1V 0HB, UK
| | - Annick Bogaerts
- KU Leuven, Department of Development and Regeneration, Research Unit Women and Child, B-3000, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Plymouth, Devon, PL4 8AA, UK
| | - Ljiljana Jeličić
- Cognitive Neuroscience Department, Institute for Research and Development "Life Activities Advancement Center", Belgrade, Serbia.,Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Paulina Pawlicka
- Department of Social Sciences, Institute of Psychology, University of Gdańsk, Gdańsk, Poland
| | - Sarah Van Haeken
- KU Leuven, Department of Development and Regeneration, Research Unit Women and Child, B-3000, Leuven, Belgium.,Research and Expertise, Resilient People, University College Leuven-Limburg, Diepenbeek, Belgium
| | - Nazihah Uddin
- Centre for Maternal and Child Health Research, City, University of London, London, EC1V 0HB, UK
| | - Rita Borg Xuereb
- Department of Midwifery, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Natalija Kolesnikova
- Centre for Maternal and Child Health Research, City, University of London, London, EC1V 0HB, UK
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15
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Slade PP, Molyneux DR, Watt DA. A systematic review of clinical effectiveness of psychological interventions to reduce post traumatic stress symptoms following childbirth and a meta-synthesis of facilitators and barriers to uptake of psychological care. J Affect Disord 2021; 281:678-694. [PMID: 33220947 DOI: 10.1016/j.jad.2020.11.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 01/30/2023]
Abstract
AIM To review the literature on psychological interventions for post-traumatic stress following childbirth (PTSDFC) and determine clinical effectiveness. To synthesise the qualitative literature on the facilitators and barriers to uptake of care for PTSDFC. BACKGROUND The context of childbirth trauma differs from that of other events perceived as traumatic. Current guidance on treatment for PTSDFC requires further clarification. METHOD Web of Knowledge, CINAHL, MEDLINE, PSYCINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), Open Grey, UKCTG, and the ISRCTN were consulted to include journal articles published in English.. Articles were segregated according to methodology and appraised using the Mixed Methods Appraisal Tool. RESULTS A total of 5355 papers were identified with five quantitative and 13 qualitative included in the review. Four types of interventions were identified: eye movement desensitisation and reprocessing, trauma focussed CBT, debriefing and expressive writing. All showed some effectiveness in treating PTSDFC. Themes emerging from the meta-synthesis included women finding it difficult to recognise having a problem, needing validation and only seeking help 'at breaking point'. Women wanted health professionals actively asking in a non-judgemental way at different time points and providing support and listening, ideally with continuity of carer to make sense of their experiences. LIMITATIONS Quantitative studies were not disaggregated by intervention timing or follow-up duration. A single independent reviewer with team discussion was utilised. CONCLUSION There is little definitive evidence assessing the effectiveness of psychological interventions for PTSDFC. There are psychological barriers for women accessing help for traumatic childbirth which services can mitigate.
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Affiliation(s)
| | - Dr Rebecca Molyneux
- Faculty of Health and Life Sciences, University of Liverpool, United Kingdom
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16
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Thomson G, Garrett C. Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England. Midwifery 2019; 71:63-70. [DOI: 10.1016/j.midw.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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17
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Beck CT, Watson S, Gable RK. Traumatic Childbirth and Its Aftermath: Is There Anything Positive? J Perinat Educ 2018; 27:175-184. [PMID: 30364308 DOI: 10.1891/1058-1243.27.3.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Up to 45% of new mothers have reported experiencing birth trauma. For some individuals who have experienced a traumatic event, there can be a positive legacy called posttraumatic growth. Using Tedeschi and Calhoun's Posttraumatic Growth Model as the theoretical framework, the purpose of this pilot study was to determine levels of posttraumatic stress, core beliefs disruption, and posttraumatic growth in women who have experienced traumatic childbirth. Thirty mothers completed the Posttraumatic Stress Disorder Symptom Scale-Self Report, Core Beliefs Inventory, and Posttraumatic Growth Inventory. Type of birth and length of time since the traumatic birth occurred predicted 38% of the variance in posttraumatic growth. In order to help mothers, childbirth educators need to understand the process involved in posttraumatic growth.
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18
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Cheng BH, Chen JH, Wang GH. Psychological factors influencing choice of prenatal diagnosis in Chinese multiparous women with advanced maternal age. J Matern Fetal Neonatal Med 2018; 32:2295-2301. [PMID: 29402153 DOI: 10.1080/14767058.2018.1432038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bi-Heng Cheng
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China
- Postdoctoral Circulation Station of Clinical Medicine, Wuhan University, Wuhan, China
| | - Jian-Hua Chen
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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Women's experiences of living with postnatal PTSD. Midwifery 2018; 56:70-78. [DOI: 10.1016/j.midw.2017.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 11/21/2022]
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20
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Hall PJ, Foster JW, Yount KM, Jennings BM. Keeping it together and falling apart: Women's dynamic experience of birth. Midwifery 2017; 58:130-136. [PMID: 29353129 DOI: 10.1016/j.midw.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the complexity of women's birth experiences in the context in which they occur and to describe how these influence women's well-being in labor. DESIGN Qualitative method with a phenomenological approach, following the analysis principles of van Manen. PARTICIPANTS AND SETTING Eight women from different ethnic and socioeconomic backgrounds in Atlanta, Georgia, United States with a recent, healthy birth were interviewed twice about their experience of the labor journey. The first interview was 3-12 weeks post-partum, with the second interview at 10-22 weeks post-partum. FINDINGS The phenomenon of childbirth was a dynamic fluctuating between keeping it together and falling apart. The changes in emotion were created by a sensitive feedback loop between the woman and her environment, the physical space, and interactions with humans present. Four characteristics supported and created this phenomenon: confidence, comfort, agency and connection. Confidence was believing in one's physical ability to birth the baby while at the same time, having the emotional resources to cope with the experience. Comfort was essential to manage pain and difficult emotions. The presence of comfort changed the meaning and experience of pain and increased relaxation. Agency was overtly supported in labor, but compromised by hospital routine and unresponsive caregiver practices, and was diminished by women's vulnerability in labor. When agency was compromised, falling apart increased, and there was a move towards intense negative emotion. In labor, women wanted an authentic human connection, being known as a person. This connection was a mechanism to support the other characteristics of comfort, confidence, and agency. IMPLICATIONS FOR PRACTICE Clinicians need to accommodate the complex, dynamic fluctuations of emotion during birth addressing both the physical and non-physical aspects of the person. Birth care practices and childbirth research need to account for the complexity of birth as a holistic experience, specifically regarding the emotional shifts as well as the women's sensitivity to the environment and everything contained in it. There is a need for more research related to the dynamics of emotional changes in labor, how these changes affect labor physiology and influence normal birth and birth outcomes.
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Affiliation(s)
- Priscilla J Hall
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta 30322, Georgia.
| | - Jennifer Whitman Foster
- Lillian Carter Center for Global Health&Social Responsibility, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta 30322, Georgia.
| | - Kathryn M Yount
- Department of Behavioral Sciences&Health Education, Department of Sociology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 7029, Atlanta 30322, Georgia.
| | - Bonnie Mowinski Jennings
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta 30322, Georgia.
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Elmir R, Pangas J, Dahlen H, Schmied V. A meta-ethnographic synthesis of midwives' and nurses' experiences of adverse labour and birth events. J Clin Nurs 2017; 26:4184-4200. [PMID: 28722761 DOI: 10.1111/jocn.13965] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Health professionals are frequently exposed to traumatic events due to the nature of their work. While traumatic and adverse labour and birth events experienced by women are well researched, less attention has been given to midwives' and nurses' experiences of these events and the impact it has on their lives. AIMS AND OBJECTIVES To undertake a meta-ethnographic study of midwives' and nurses' experiences of adverse labour and birth events. METHODS Scopus, CINHAL PLUS, MEDLINE and PUBMED databases were searched using subject headings and keywords. The search was limited to papers published in peer-reviewed journals from 2004-October 2016. Quality appraisal was undertaken using the Critical Appraisal Skills Programme tool. INCLUSION CRITERIA Papers had to be qualitative or have a substantial qualitative component. Studies were included if they primarily focused on midwives' or nurses' perspectives or experiences of complicated, traumatic or adverse labour and birth events. ANALYTIC STRATEGY A meta-ethnographic approach was used incorporating methods of reciprocal translation guided by the work of Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies (Vol. 11). Newbury Park: Sage publications). FINDINGS Eleven qualitative studies were included in the final sample. Four major themes were (i) feeling the chaos; (ii) powerless, responsible and a failure; (iii) "It adds another scar to my soul"; and (iv) finding a way to deal with it. CONCLUSION Midwives and nurses feel relatively unprepared when faced with a real-life labour and birth emergency event. While many of the midwives and nurses were traumatised by the experience, some were able to view their encounter as an opportunity to develop their emergency response skills. RELEVANCE TO CLINICAL PRACTICE Witnessing and being involved in a complicated or adverse labour and birth event can be traumatic for nurses and midwives. Organisational and collegial support needs to be available to enable these health professionals to talk about their feelings and concerns.
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Affiliation(s)
- Rakime Elmir
- School of Nursing and Midwifery, Affiliate Centre of Applied Nursing Research (CANR), Western Sydney University, Penrith, NSW, Australia
| | - Jackie Pangas
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
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