Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports

Racializing Motherhood and Maternity Care in News Representations of Breastfeeding

Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.

Consensus-based recommendations for the care of women with a breech presenting fetus

OBJECTIVE

To establish consensus related to aspects of breech presentation and care.

DESIGN

A multinational, three round e-Delphi study.

PARTICIPANTS

A panel of 15 midwives, four obstetricians and an academic with knowledge and/or experience of caring for women with a breech presenting fetus.

METHODS

An initial survey of 45 open-ended questions. Answers were coded and amalgamated to form 448 statements in the second round and three additional statements in the third round. Panellists were asked to provide their level of agreement for each statement using a 5-point Likert scale. Consensus was deemed met if 70% of panellists responded with strongly agree to somewhat agree, or strongly disagree to somewhat disagree after the second round.

FINDINGS

Results led to the development of a consensus-based care pathway for women with a breech presenting fetus and a skills development framework for clinicians.

KEY CONCLUSIONS

A cultural shift is beginning to occur through the provision of physiological breech workshops offered by various organisations and may result in greater access to skilled and experienced clinicians for women desiring a vaginal breech birth, ultimately improving the safety of breech birth.

IMPLICATIONS FOR PRACTICES

The care pathway and skills development framework can be used by services wishing to make changes to their current practices related to breech presentation and increase the level of skill in their workforce.

What are women's experiences of seeking to plan a vaginal breech birth? A systematic review and qualitative meta-synthesis

Background

Guidelines for breech management at term emphasise choice and informed decision-making. Despite this, the choice of vaginal breech birth (VBB), is not always available or accessible. We aimed to describe the experiences of women seeking a VBB as reported in primary research and to offer strategies for improving this experience that are grounded in evidence.

Methods

We conducted a systematic review and qualitative meta-synthesis of the results, using grounded theory analysis methods (PROSPERO registration CRD42021262380), with literature published between January 2000 and February 2022. Seven databases were searched. Our review included literature about women with breech presentation, who sought a planned or unplanned VBB. Studies considering only experiences of alternative management (e.g. caesarean, external cephalic version), and those investigating healthcare workers' experiences were excluded. Covidence systematic review software was used for screening and quality assessment. Qualitative data were extracted using NVivo software (20.5.0). Data were analysed through an iterative process based on constant comparison methods, with an iterative and reflexive code generation process. Codes were then arranged into 'categories of experience', which gave rise to over-arching themes.

Results

Our review included 19 studies. We present one overarching theory: 'Women who wish to plan a vaginal breech birth seek connected autonomy'. Our schematic, depicting this theory, includes seven main categories of experience: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy.

Conclusions

Women seeking to plan a VBB feel vulnerable and wish to connect with capable and confident healthcare providers. To meet their needs, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also seek to limit their exposure to disrespectful and judgemental interactions with healthcare providers.

Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study

BACKGROUND

The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section.

OBJECTIVE

This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women's experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback.

METHODS

A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals' knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time.

RESULTS

Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete.

CONCLUSIONS

The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/23514.

Radiology in the News: A Content Analysis of Radiology-Related Information Retrieved From Google Alerts

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Google Alerts highlighted a diverse set of topics present in online media.

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Most links were directly to non-radiology lay press, but <1% of links over the 6-month period sent the user directly to a primary peer-reviewed medical journal article.

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The most common topics were market trends, promotional, COVID-19, and artificial intelligence.

Introduction

Radiology topics receive substantial online media attention, with prior studies focusing on social media platform coverage. We used Google Alerts, a content change detection and notification service, to prospectively analyze new radiology-related content appearing on the internet.

Materials and Methods

An automated notification was created on Google Alerts for the search term “radiology,” sending the user emails with up to 3 new links daily. All links from November 2019 through April 2020 were assessed by 2 of 3 independent raters using a coding system to classify the content source and primary topic of discussion. The top 5 primary topics were retrospectively evaluated to identify prevalent subcategories. Content viewing restrictions were documented.

Results

526 links were accessed. The majority (68%) of links were created by non-radiology lay press, followed by radiology-related lay press (28%), university-based publications (2%), and professional society websites (2%). The primary topic of these links most frequently related to market trends (28%), promotional material (20%), COVID-19 (13%), artificial intelligence (8%), and new technology or equipment (5%). 15% of links discussed a topic sourced from another article, such as a peer-reviewed journal, though only 2 linked directly to the journal itself. 8% of links had content viewing restrictions.

Conclusion

New radiology content was largely disseminated via non-radiology news sources; radiologists should therefore ensure their research and viewpoints are presented in these outlets. Google Alerts may be a useful tool to stay abreast of the most current public radiology subject matters, especially during these times of social isolation and rapidly evolving clinical practice.

'Dr. Google, is caesarean section good for me?' - the global Internet searches associated with mode of birth methods: Retrospective analysis of Google trends data

OBJECTIVE

We investigated Google queries in the years 2004-2019 as related to mode of birth methods in scope of global and local popularity, secular trends, and associations with real-world data.

DESIGN

We retrieved data from Google Trends (GT) over time and regional interest in (n = 9) topics related to birth. We calculated the interest of all the topics in proportion to the Relative Search Volume (RSV) of 'Caesarean section'"(CS). We retrieved WHO data on the CS rate and the World Bank data on the fertility rate. We analysed secular trends.

FINDINGS

Globally, the highest popularity was observed for these topics: 'Childbirth' (6.93 [times higher than CS]), 'Caesarean section' (1.00), and 'Preterm birth' (0.59). The regional RSV of 'Caesarean section' was associated with the real CS rate (r = 0.29; p = 0.016) and the interest in 'Childbirth' was associated with the regional fertility rate (r = 0.48; p < 0.001). Globally, the most dynamic rate of increase of interest was observed for 'Vaginal delivery' (+4.96 RSV/year) and 'Caesarean section' (+4.88 RSV/year), while a decrease was noted only for 'Home birth' (-3.04 RSV/year) and 'Water birth' (-1.84 RSV/year).

CONCLUSIONS

The interest of Google users in most of the birth-related topics increased over time and is associated with real-world data. Using GT may provide insight into the interest of Google users regarding different birth-related matters.

IMPLICATION FOR PRACTICE

Health professionals should be active in e-discourse to provide reliable information and recommend trustworthy websites to women and those who support them.

Changing messages about place of birth in Mother and Baby magazine between 1956 and 1992

OBJECTIVE

this paper explores changing messages about place of birth offered to women by Mother and Baby magazine, a UK publication aimed at a general readership DESIGN: the research uses an historical perspective to explore changing messages about place of birth in Mother and Baby magazine between 1956-1992. It analyses the content and medium of the magazine through a narrative and semiotic approach.

SETTING

the UK between the mid-1950s and 1990s. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with a move towards hospital rather than home birth and a dominant discourse which privileged medical models of care over social ones.

PARTICIPANTS

producers and consumers of Mother and Baby magazine FINDINGS: Mother and Baby moved from an assumption of home birth to a focus on hospital birth, reflecting national changes in policy. The magazine moved from a social to a risk focused medical view of birth, with an emphasis on the safety of the baby and the sacrifice of the mother. These changes can be traced through both the organisation and the language of content between 1956 and 1992. However, home birth was always offered to readers as a viable, if increasingly niche, option. This reflected the magazine's need to appeal to its readers as consumers; both in consumption of the magazine and of maternity care.

CONCLUSIONS

the evidence suggests that Mother and Baby magazine mirrored elements of the prevailing policy discourse around place of birth. However, it always gave space to other narratives. In doing so it reminds us of the complexity about how messages about labour and birth are told and received. It gives insight into ways in which the media lead and reflect change and the impact this might have on decision making by women.