A systematic review and narrative synthesis of fathers' (including migrant fathers') experiences of pregnancy and childbirth.

OBJECTIVE: The purpose of this review was to consider factors that influence the experiences of pregnancy and childbirth by fathers including migrant fathers. METHOD: A systematic review and narrative synthesis were conducted as per the PRISMA guidelines. The spider tool was used to build a search strategy which was used to conduct literature search in eight identified electronic databases: ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO, PUBMED, Sage and Scopus. Grey literature was searched through the King's Fund Library database, Ethos, The North Grey Literature Collection, Social Care Online and other charity websites such as the Refugee Council and Joseph Rowntree Foundation. The search was conducted across all the databases in the week commencing January 7, 2019, and restricted to studies published in the English language. RESULTS: The search across all the eight electronic databases identified 2564 records, 13 records through grey literature databases/websites and an additional 23 records identified through hand-searching/forward citation. The number of records after duplicates were removed was 2229. Record screening based on titles and abstracts identified 69 records for full text screening. Dual screening of these full text records identified 12 full records from 12 separate studies, eight of which were qualitative studies, three of which were quantitative studies and one mixed method study. FINDINGS: This review has revealed three main themes: influence of society and health professionals; adjustment to a new life of fatherhood; and involvement in maternity care. However, the literature has focused on non-migrant father's experiences of pregnancy and childbirth, with little attention paid to fathers who may be migrants. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: This review has exposed a dearth of research on migrant fathers' experiences of pregnancy and childbirth in an era of increasing globalisation and migration between countries. Midwives and other health professionals should be alert to the needs of any father when providing maternity care. More research is needed which considers experiences of migrants and how choosing to move to a new country or being forced to move could influence migrant father's experiences and therefore their needs.

Culture and communication in ethically appropriate care.

This article considers the difficulties with using Gillon's model for health care ethics in the context of clinical practice. Everyday difficulties can arise when caring for people from different ethnic and cultural backgrounds, especially when they speak little or no English. A case is presented that establishes, owing to language and cultural barriers, that midwives may have difficulty in providing ethically appropriate care to women of Pakistani Muslim origin in the UK. The use of interpreters is discussed; however, there are limitations and counter arguments to their use. Training is identified as needed to prepare service providers and midwives for meeting the needs of a culturally diverse maternity population.

Vaginal birth after caesarean section (VBAC): exploring women's perceptions.

AIMS AND OBJECTIVES: This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. BACKGROUND: The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. DESIGN AND METHODOLOGY: Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. RESULTS: This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. CONCLUSIONS: Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. RELEVANCE TO CLINICAL PRACTICE: This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.

Student self-assessment and its impact on learning - a pilot study.

Student self-assessment is widely reported to offer numerous advantages to the learner. It is a popular practice for empowering students and the advantages are claimed to incorporate increased dialogue between students and teachers and the development of skills that encompass critical awareness and reflectivity. It is, potentially, a process that may enable health care practitioners to be lifelong learners, equipped with the skills for autonomy in learning and professional practice. As such it might be viewed as an essential element of the curriculum. This paper reports on a study designed to evaluate the implementation of self-assessment among student health care practitioners. The pilot study examined the impact of self-assessment on learning and how the process was perceived by students and staff. Findings indicated that a varied approach had been taken to its implementation, which had significant repercussions in the way in which it was perceived by students. Similarly, there was a varied approach taken by students to the process of self-assessment and this had significant repercussions for its overall value as a learning tool. The outcomes of this study provide a sound rational for maintaining and expanding the practice of student self-assessment and important lessons for the process of doing so.