The importance of face to face, group antenatal education classes for first time mothers: A qualitative study.

OBJECTIVES: To explore and understand perspectives of women expecting their first child and why they wanted to attend NHS antenatal education. This included what worries and concerns they wanted to be addressed and why this would be beneficial. It also included what they wanted their partners to be able to gain from attending classes. DESIGN: A longitudinal qualitative study using Template Analysis was undertaken with data collection during pregnancy and postpartum. A semi-structured topic guide was used to guide data collection, either via focus groups or one to one interviews which were audio recorded and transcribed. SETTING: National Health Service Trusts providing maternity services to women for labour and birth, purposively selected to allow the perspectives of specific groups of women to be included. PARTICIPANTS: Women expecting their first child from one of three groups: Women from the general population aged 20 years or more, women from ethnic minority groups and young women aged 16 to 19 years. FINDINGS: Eighty-two pregnant women participated. Three substantive themes are reported: the search for information, the functions of antenatal classes, and the specific information desired. Women wanted to attend NHS antenatal education to access trustworthy information that would reassure, increase confidence, and help them feel prepared. Women wanted to meet others in the same situation to help normalise concerns and offer the potential for ongoing relationships. Classes were seen as a way to help partners engage more fully with the transition to parenthood. Specific information required and shared by all groups was around understanding the stages of labour, managing labour, and common interventions. CONCLUSIONS: Access to a wide range of information increases women's anxieties about labour that women want addressed through antenatal education. However, antenatal classes serve broader functions beyond information- giving and women anticipate that attending antenatal classes will address both their own and their partners' needs. IMPLICATIONS: Service providers should ensure their antenatal education provision provides the information required and is structured in a way that enables women to develop relationships and supports partners' engagement in the transition to parenthood.

Women's expectations and experiences of rupture of membranes and views of the potential use of reagent pads for detecting amniotic fluid.

AIMS: To explore first-time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid. BACKGROUND: There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of membranes (e.g. reagent pads). DESIGN: Descriptive qualitative study, using focus groups and telephone interviews with women during pregnancy and after the birth of their first baby. Thematic analysis was undertaken to analyse women's responses. METHODS: Ethics committee approval was obtained. Twenty-five women participated in the study of whom 13 contributed both during pregnancy and postpartum between October 2015-March 2016. FINDINGS: Three overarching themes were identified from the data from women's expectations and experiences: uncertainty in how, when and where membranes may rupture; information which was felt to be limited and confirmation of rupture of membranes. The potential use of reagent pads met with varied responses. CONCLUSION: Women were interested in having facts and figures regarding rupture of membranes, such as characteristics of liquor; volume and probability of membranes rupturing spontaneously at term. Use of a pad as a means of confirmation was viewed as helpful, although the potential for increasing anxiety was raised.

Motor Development Interventions for Preterm Infants: A Systematic Review and Meta-analysis.

CONTEXTS: Preterm infants are at an increased risk of neurodevelopmental delay. Some studies report positive intervention effects on motor outcomes, but it is currently unclear which motor activities are most effective in the short and longer term. OBJECTIVE: The aim of the study was to identify interventions that improve the motor development of preterm infants. DATA SOURCES: An a priori protocol was agreed upon. Seventeen electronic databases from 1980 to April 2015 and gray literature sources were searched. STUDY SELECTION: Three reviewers screened the articles. DATA EXTRACTION: The outcome of interest was motor skills assessment scores. All data collection and risk of bias assessments were agreed upon by the 3 reviewers. RESULTS: Forty-two publications, which reported results from 36 trials (25 randomized controlled trials and 11 nonrandomized studies) with a total of 3484 infants, met the inclusion criteria. A meta-analysis was conducted by using standardized mean differences on 21 studies, with positive effects found at 3 months (mean 1.37; confidence interval 0.48-2.27), 6 months (0.34; 0.11-0.57), 12 months (0.73; 0.20-1.26), and 24 months (0.28; 0.07-0.49). At 3 months, there was a large and significant effect size for motor-specific interventions (2.00; 0.28-3.72) but not generic interventions (0.33; -0.03 to -0.69). Studies were not excluded on the basis of quality; therefore, heterogeneity was significant and the random-effects model was used. LIMITATIONS: Incomplete or inconsistent reporting of outcome measures limited the data available for meta-analysis beyond 24 months. CONCLUSIONS: A positive intervention effect on motor skills appears to be present up to 24 months' corrected age. There is some evidence at 3 months that interventions with specific motor components are most effective.

'SINK or SWIM': the experience of newly qualified midwives in England.

OBJECTIVE: To explore newly qualified midwives' and preceptors' view of the preceptorship period. DESIGN: Qualitative design utilising focus groups as a means of collecting data. SETTING: Hospital trusts partnered with three Universities in England. PARTICIPANTS: In total there were 62 participants; 40 newly qualified midwives, 20 preceptors and two practice development midwives participated in focus group interviews. FINDINGS: The findings suggested that newly qualified midwives and preceptors found it difficult to meet due to time constraints and either working different shifts or in different clinical areas. In addition three main themes emerged in relation to what affected effective preceptorship. The most important areas to improve the preceptorship period were to appoint midwives responsible for the organisation and support of newly qualified midwives. In addition, each new midwife should have a programme tailored to their needs which avoids repetitive learning. CONCLUSIONS: The transition period causes anxiety for newly qualified midwives, especially when there is a long delay between qualification and taking up their first post. There appears to be some confusion over induction and preceptorship paperwork. The majority of midwives described their initial experience of working as a qualified midwife as 'SINK or SWIM'.

"There are guiding hands and there are controlling hands": student midwives experience of mentorship in the UK.

OBJECTIVE: to explore student midwives' experience and views on the role of the mentor in practice, and to survey perceptions of the qualities required for mentorship. DESIGN: qualitative longitudinal cohort study using focus groups. SETTING: an academic division of midwifery at a university in the East Midlands region of the UK. PARTICIPANTS: 58 women enrolled in a three-year midwifery education programme at the university. MEASUREMENTS: the focus groups were conducted with two cohorts of midwifery students at four time points during their three-year education programme. FINDINGS: the themes that emerged from the data were: qualities of good mentors; relationships; expectations of mentors; role models; and mentorship experience. CONCLUSIONS: mentors are used as role models by the students in both positive and negative ways. The relationship that the student has with a mentor is fundamental to their confidence in practice, although there is an appreciation that sometimes there are problems with personality clashes. Expectations of the mentor are a major issue for student midwives, and this can be affected by the length of time they have worked with a mentor. There was general consensus about the qualities of a good mentor.

Perceptions of motherhood: The effect of experience and knowledge on midwifery students.

OBJECTIVE: to explore the factors that influence student midwives' constructs of childbearing, before and during their undergraduate midwifery programme. DESIGN: a naturalistic, qualitative study. SETTING: a university in the East Midlands, UK. PARTICIPANTS: 58 women registered on a 3-year midwifery education programme. MEASUREMENTS: focus groups were conducted at programme commencement and at 9-12 monthly intervals with two cohorts of midwifery students who were separated into groups of mothers and non-mothers (32 focus groups in total). This paper draws on data from the nine focus groups held at the start of the students' programme. FINDINGS: the main themes that emerged from the data were in relation to image during pregnancy, expectations/experiences of childbirth and parenting. In particular, students believed that pregnancy and childbirth should be special. They suggested that a lack of knowledge about sexuality and choice options affected women's ability to be in control. Although normality was the students' expectation of childbirth, they also assumed that hospital birth was the norm. They were unsure whether the baby's father was the best birth partner. Their mothers were suggested as likely to be more supportive, but there was lack of agreement regarding whether they were the best parenting role models. Students also said that there was a lack of positive images of breast feeding. The overall motivation to become midwives was 'to make a difference'. CONCLUSIONS: students need to be facilitated early in their programme to explore their belief systems and constructs of childbearing critically so that they are equipped to support parents to have a positive experience, whether childbirth is normal or complex, and so that they can cope with any dissonance between their own expectations and the uncertainties and realities of practice.