Exploring psychological factors associated with breastfeeding in women with a BMI ≥ 30 kg/m2.

OBJECTIVE: Women with a BMI ≥ 30 kg/m2 are less likely to initiate and maintain breastfeeding compared to normal-weight women. Psychological factors have been linked with breastfeeding, but their influence on women with a BMI ≥ 30 kg/m2 experiences needs further exploration. The aim of this study was to investigate whether psychological factors are voiced by women with a BMI ≥ 30 kg/m2, and how these factors influence their breastfeeding. DESIGN: A secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/m2 who had breastfed. MAIN OUTCOME MEASURES: Deductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women's breastfeeding experiences. RESULTS: All psychological factors were reported as part of women's experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found. CONCLUSIONS: Psychological factors influence women's breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m2 has been developed, and can inform future intervention development.

Contraceptive unmet needs in low and middle-income countries: A systematic review.

Contraceptive use in sub-Saharan Africa remains low, with a minimal rise from 23.6% to 28.5% between 2008 and 2015. Unmet needs for contraception remain a public health concern in low and middle-income countries. The objectives of this systematic review were to explore the perceptions of women and men accessing family planning services; and the perceptions of healthcare professionals delivering family planning services in low and middle-income countries. Literature search was limited to studies published in English in the period from 2000 to 2017. Thirty studies included in this review were identified from CINAHL, BNI, EMBASE, PsycINFO, MIDIRS and MEDLINE databases. A narrative synthesis, was adopted to synthesise the findings. Findings indicate a lack of awareness of contraception amongst women and men. Experienced and perceived side effects of contraceptives influence contraceptive continuation and discontinuation. Evidence from this review points to the need for awareness of contraception to dispel myths and misperceptions regarding modern contraception.

Fear of birth in clinical practice: A structured review of current measurement tools.

To identify measurement tools which screen for the presence of fear of birth (FOB) and to determine the most effective tool/s for use in clinical practice. Fear or birth (FOB) is internationally recognised as a cause for increasing concern, despite a lack of consensus on a definition or optimal measure of assessment. There is a wide array of FOB measurement tools, however little clarity on which tool should be used to screen for FOB in clinical practice. This review explores the use of tools that are used to screen for FOB and discusses the perceived effectiveness of such tools. A structured literature review was undertaken. Electronic databases were searched in July 2017 and manuscripts reviewed for quality. The review included 46 papers. The majority of studies were undertaken in Scandinavia (n = 29) and a range of tools were used to measure FOB. The most widely used tool was the Wijma Delivery Expectancy Experience Questionnaire' (W-DEQ). Inconsistencies were found in the way this tool was used, including variations in assessment cut-off points, implementation and use across a range of cultural settings and women of varying gestations. Moreover, the tool may be too lengthy to use in clinical practice. The Fear of Birth Scale (FOBS) has been shown to be as effective as W-DEQ but has the advantage of being short and easy to administer. The inconsistencies in tools reflect the difficulties in defining FOB. A clear consensus definition of FOB would aid comparisons across practice and research. The W-DEQ is not used in clinical practice; this may be due to its length and complexity. The FOBS is likely to be a more versatile tool that can be used in clinical practice.

A realist review of the partograph: when and how does it work for labour monitoring?

BACKGROUND: The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use. METHODS: This review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis. RESULTS: The evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators. CONCLUSIONS: This first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.

Improving quality of care during labour and childbirth and in the immediate postnatal period.

Quality of care during labour and childbirth and in the immediate postnatal period is important in ensuring healthy maternal and newborn survival. A narrative review of existing quality frameworks in the context of evidence-based interventions for essential care demonstrates the complexities of quality of care and the domains required to provide high quality of care. The role of the care provider is pivotal to optimum care; however, providers need appropriate training and supervision, which should include assessment of core competencies. Organisational factors such as staffing levels and resources may support or hinder the delivery of optimum care and should be observed during any monitoring. The woman's perspective is central to all quality of care strategies; her opinion should be sought where possible. The importance of assessing and monitoring quality of care during such a critical period should be appreciated. A number of quality frameworks offer organisations with a foundation on which they can deliver high quality care.

Is accurate and reliable blood loss estimation the 'crucial step' in early detection of postpartum haemorrhage: an integrative review of the literature.

BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and severe maternal morbidity in many high-income countries. Poor outcomes following PPH are often attributed to delays in the recognition and treatment of PPH. Experts have suggested that improving the accuracy and reliability of blood loss estimation is the crucial step in preventing death and morbidity from PPH. However, there is little guidance on how this can be achieved. The aim of this integrative review was to evaluate the various methods of assessing maternal blood loss during childbirth. METHODS: A systematic, integrative review of published research studies was conducted. All types of studies were included if they developed, tested, or aimed to improve methods and skills in quantifying blood loss during childbirth, or explored experiences of those involved in the process. RESULTS: Thirty-six studies were included that evaluated the accuracy of visual estimation; tested methods to improve skills in measurement; examined their effect on PPH diagnosis and treatment, and / or explored additional factors associated with blood loss evaluation. The review found that health professionals were highly inaccurate at estimating blood loss as a volume. Training resulted in short term improvements in skills but these were not retained and did not improve clinical outcomes. Multi-faceted interventions changed some clinical practices but did not reduce the incidence of severe PPH or the timing of responses to excessive bleeding. Blood collection bags improved the accuracy of estimation but did not prevent delays or progression to severe PPH. Practitioners commonly used the nature and speed of blood flow, and the condition of the woman to indicate that the blood loss was abnormal. CONCLUSIONS: Early diagnosis of PPH should improve maternal outcomes, but there is little evidence that this can be achieved through improving the accuracy of blood loss volume measurements. The diagnosis may rely on factors other than volume, such as speed of blood flow and nature of loss. A change in direction of future research is required to explore these in more detail.