The influence of antenatal relaxation classes on perinatal psychological wellbeing and childbirth experiences: a qualitative study.

BACKGROUND: There is growing evidence that antenatal education incorporating relaxation practices can positively influence perinatal psychological wellbeing. However, a paucity of qualitative research is evident. Gaining insight into how and why such education may influence childbearing women, can inform the design of effective educational interventions. This study aimed to explore the perspectives of women and their partners on how and why a single Antenatal Relaxation Class (ARC) might influence perinatal psychological wellbeing and childbirth experiences. METHOD: In this descriptive qualitative study, 17 women and 9 partners participated in semi-structured in-depth interviews and the data were analysed using thematic analysis. The study was carried out in a Scottish NHS Health Board where ARC was provided to expectant parents. FINDINGS: Two themes were generated, namely: 'the turning point', and 'recognition of an inner resource'. Participants perceived ARC as 'the turning point' when they became more confident, equipped, and less fearful and anxious towards childbirth. 'Understanding of the psychophysiological processes of childbirth', 'positive stories', and 'practice of relaxation techniques' were reported as the main reasons for these positive changes. Participants explained ARC had enabled them to access a deep sense of calmness as 'an inner resource' and motivated the use of relaxation techniques as a self-care behaviour throughout pregnancy and childbirth. CONCLUSION: A single antenatal relaxation class has the potential to enhance perinatal psychological wellbeing and childbirth experiences. This study provides valuable insights for maternity services seeking to develop effective health-promoting antenatal education.

'Doing' is never enough, if 'being' is neglected. Exploring midwives' perspectives on the influence of an emotional intelligence education programme, a qualitative study.

BACKGROUND: The role of the midwife is emotionally demanding with many midwives experiencing high levels of stress and burnout, and a great number considering leaving the profession. This has serious implications for the delivery of high-quality, safe maternity care. One of the major factors leading to job dissatisfaction is the conflict between midwives' aspiration of truly 'being' with the woman and the institutional expectations of the role which focuses on the 'doing' aspects of the job. 'Being' present to a woman's psychological needs, whilst meeting the institutional demands, requires high levels of emotional intelligence (EI) in the midwife. Therefore, enhancing midwives' EI could be beneficial. EI EDUCATION PROGRAMME: An EI programme was made available to midwives with the intention to promote their emotional intelligence and enable them to utilise relaxation techniques for those in their care. AIM: To explore midwives' perspectives on the influence of the EI education programme on their emotional wellbeing and experiences of practice. METHOD: The study took a descriptive qualitative approach. Thirteen midwives participated in focus group interviews. The data were analysed using thematic analysis. FINDINGS: The overarching theme of 'The Ripple Effect' included three themes of 'Me and my relationships', 'A different approach to practice' and 'Confidence and empowerment'. The programme was seen to create a positive ripple effect, influencing midwives personally, their approach to practice, and feelings of confidence in their role. CONCLUSION: EI education can reduce emotional stress in midwives, enhance their empathy and feelings of confidence, thus, improving the quality of care they provide.

Alcohol use in Australia: countering harm with healing.

Harmful use of alcohol consumption in Australia is a serious socio-political and public health issue that is exacerbated by exploitative marketing campaigns by the alcohol industry. In Indigenous populations harmful alcohol use is directly related to the legacy of colonisation that has led to complex social issues and adverse intergenerational trauma. To effectively address alcohol-related harm in Australia, it is necessary to critically apply the 'Three Pillars of Harm Minimisation', which are demand reduction, supply reduction, and harm reduction. This can be facilitated through approaches such as the 'Interplay Wellbeing Framework', which situates concepts of wellbeing and risky alcohol use within the context of systemic inequities across all social determinants of health. Culturally responsive approaches embody a holistic view of community, mutually respectful collaboration, culture, healing, and self-determined change. This is underpinned by Indigenous leadership that promotes existing resistance, resilience, interpersonal relationships, and strengths that instil healing to counter the harms associated with alcohol use.

Consent during labour and birth as observed by midwifery students: A mixed methods study.

BACKGROUND: While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives' and women's experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process. AIM: The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth. METHODS: An online survey was distributed via universities and social media to final year midwifery students across Australia. Likert scale questions based on the principles of informed consent (indications, outcomes, risks, alternatives, and voluntariness) were posed for intrapartum care in general and for specific clinical procedures. Students could also record verbal descriptions of their observations via the survey app. Recorded responses were analysed thematically. FINDINGS: 225 students responded with 195 completed surveys; 20 students provided audio recorded data. Student's observations suggested that the consent process varied considerably depending on the clinical procedure. Discussions of risks and alternatives during labour were frequently omitted. DISCUSSION: The student's accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives' preferences. CONCLUSIONS: Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives.

Factors That Influence the Sustainability of Human Milk Donation to Milk Banks: A Systematic Review.

Donor human milk is the recommended alternative for feeding preterm or low birth weight infants when the mother's own milk is unavailable or not in sufficient quantity. Globally, the needs of vulnerable infants for donor human milk exceed the supply. This review aimed to identify the factors impacting the sustainability of human milk donation to milk banks. A systematic review of the literature was performed on eight databases to retrieve articles published until December 2021. The study protocol is available in PROSPERO (#CRD42021287087). Among the 6722 references identified, 10 studies (eight quantitative observational and two qualitative) met the eligibility criteria for a total of 7053 participants. Thirty factors influencing the sustainability of the donations to milk banks were identified and categorized as follows: (1) donation duration, (2) donors' infant features (e.g., gestational age, birth weight), (3) donors' features (e.g., socio-demographic characteristics, milk donation history), and (4) factors related to the milk bank and health care systems (awareness and support). The available evidence suggests that larger volumes of donated milk are associated with a longer duration of donation, as are early donation, previous milk donation, and donors with an infant of smaller weight and gestational age. Supporting and encouraging early donation and recruiting donors with infants of low birth weight and low gestational age could support longer donation times and greater volumes of milk donated. To identify efficient strategies and to draw appropriate recommendations to improve donor milk access, future studies should further explore the issues of the sustainability of human milk donation to milk banks.

Expectant parents' perspectives on the influence of a single antenatal relaxation class: A qualitative study.

AIM: This study explores the perspectives of expectant parents on the influence of a single antenatal class incorporating education on childbirth physiology and relaxation techniques. METHOD: The data for this qualitative descriptive study were collected via in-depth interviews with six women and three birth partners. FINDINGS: An enhanced understanding of childbirth physiology formed a 'different way of thinking' about childbirth, 'inspired and motivated' the exertion of the learnt relaxation techniques which led to a 'deepsense of calmness' associated with increased confidence and reduced fear. However, reaching such sense of calmness during childbirth required a 'space for relaxation' which was influenced by birth attendants. An overarching theme of 'a positive outlook' towards childbirth was identified. CONCLUSION: Including education on childbirth physiology and a range of relaxation techniques may reduce fear, empower prospective parents and positively influence their experiences of pregnancy and childbirth.

Advanced practice for children and young people: A systematic review with narrative summary.

AIM: To critically appraise and synthesise the current evidence related to the advanced practice nurse (APN) in the children and young people's healthcare setting. BACKGROUND: A complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care. DESIGN: Systematic review and narrative summary. DATA SOURCES: CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria. REVIEW METHODS: The selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers. RESULTS: Nine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy. CONCLUSION: This review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators. IMPACT: The findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research.

Mode of birth after caesarean section: individual prediction scores using Scottish population data.

BACKGROUND: Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. METHODS: An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. RESULTS: Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001). CONCLUSIONS: By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.

Breastfeeding and the substance-exposed mother and baby.

BACKGROUND: Breastfeeding rates are typically low for women with a substance-use disorder. This is despite the specific benefits of breastfeeding to alleviate the severity of neonatal abstinence syndrome and the well-documented generic advantages. This study explored the feasibility of in-hospital, tailored breastfeeding support for the substance-exposed mother and baby. METHODS: This was a mixed-methods feasibility study undertaken in Scotland from April 2014 to May 2015. Women with a substance-use disorder either received standard Baby-Friendly Initiative care only or were given additional support which included a dedicated breastfeeding support worker, personalized capacity-building approach, and a low-stimuli environment for 5 days. Feasibility outcome measures were maternal recruitment, satisfaction and acceptability of support, breastfeeding on fifth postnatal day, and severity of neonatal abstinence syndrome. RESULTS: Fourteen mother-infant dyads participated. Intervention participants demonstrated higher rates of continued breastfeeding and reported a greater degree of satisfaction with support and confidence in their breastfeeding ability. Maternal experience of health care practices, attitudes, and postnatal environment influenced their perceptions of breastfeeding support. Breastfed infants were less likely to require pharmacotherapy for neonatal withdrawal and had a shorter hospital stay. CONCLUSIONS: The findings highlight the feasibility of tailored breastfeeding support for the substance-exposed mother and baby and endorse the promotion and support of breastfeeding for this group. Future research should include a statistically powered randomized controlled trial to evaluate clinical efficacy.

Quality of care provided in two Scottish rural community maternity units: a retrospective case review.

BACKGROUND: Women in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model. The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit. METHODS: Following appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics. RESULTS: Regarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth. Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs. CONCLUSION: These findings support the recommendations of professional bodies and national guidelines. Maternity service provision at rural CMUs achieved a consistently high standard of safety and effectiveness when measured against national standards and international evidence.

Breastfeeding support and opiate dependence: A think aloud study.

OBJECTIVE: international guidelines recommend the promotion and protection of breastfeeding for the substance exposed mother and baby. Yet few studies have explored the facilitators, moderators and barriers to successful breastfeeding for women enrolled on opiate maintenance treatment, or suggested targeted support strategies. The aim of this study was to explore the views of women with opiate dependence on proposed elements for inclusion in a breastfeeding support intervention. DESIGN: a qualitative study using think aloud technique. SETTING: tertiary maternity hospital in the North-East of Scotland. Interviews conducted between November 2013 and March 2014. PARTICIPANTS: 6 opiate dependent women within 6 months of giving birth. Participants were enrolled on opiate medication treatment during their pregnancy, had initiated breastfeeding and accessed in-hospital breastfeeding support. FINDINGS: an intervention founded on practical, informational and environmental elements was endorsed as supportive of continued breastfeeding of an infant at risk of Neonatal Abstinence Syndrome. Opiate dependent women were more receptive to strategies promoting a person-centered approach that were specific to their individualized infant feeding needs and delivered within an emotionally supportive environment. Barriers to the acceptability of breastfeeding advice included discouraging, prescriptive and judgemental healthcare actions and attitudes. KEY CONCLUSIONS: there are distinct facilitators, modifiers and barriers to breastfeeding within the context of opiate exposure. Using this awareness to underpin the key features of the design should enhance maternal receptiveness, acceptability and usability of the support intervention. IMPLICATIONS FOR PRACTICE: additional and tailored support interventions are required to meet the specific needs of breastfeeding an infant experiencing opiate withdrawal. The elimination of disempowering institutional actions and attitudes is imperative if a conducive environment in which opiate dependent women feel supported is to be achieved.

Patient-centered Care in Maternity Services: A Critical Appraisal and Synthesis of the Literature.

BACKGROUND: Patient-centered care (PCC) has been recognized as a marker of quality in health service delivery. In policy documents, PCC is often used interchangeably with other models of care. There is a wide literature about PCC, but there is a lack of evidence about which model is the most appropriate for maternity services specifically. AIM: We sought to identify and critically appraise the literature to identify which definition of PCC is most relevant for maternity services. METHODS: The four-step approach used to identify definitions of PCC was to 1) search electronic databases using key terms (1995-2011), 2) cross-reference key papers, 3) search of specific journals, and 4) search the grey literature. Four papers and two books met our inclusion criteria. ANALYSIS: A four-criteria critical appraisal tool developed for the review was used to appraise the papers and books. MAIN RESULTS: From the six identified definitions, the Shaller's definition met the majority of the four criteria outlined and seems to be the most relevant to maternity services because it includes physiologic conditions as well as pathology, psychological aspects, a nonmedical approach to care, the greater involvement of family and friends, and strategies to implement PCC. CONCLUSION: This review highlights Shaller's definitions of PCC as the one that would be the most inclusive of all women using maternity services. Future research should concentrate on evaluating programs that support PCC in maternity services, and testing/validating this model of care.

Supporting Breastfeeding Establishment among Socially Disadvantaged Women: A Meta-Synthesis.

BACKGROUND: Many women from socially disadvantaged groups discontinue breastfeeding in the early postnatal period before lactation is fully established. This suggests that existing health service practices do not adequately meet the breastfeeding support needs of this population. The aim of this meta-synthesis is to review the literature exploring how women from socioeconomically deprived backgrounds experience breastfeeding establishment and to identify factors associated with supportive practice. METHODS: The meta-synthesis includes qualitative studies exploring the perception of women from disadvantaged groups of in-hospital and professionally led interventions to support the establishment of breastfeeding. Searches were conducted for studies published between 1992 and 2013; after critical appraisal, eight studies were retained. RESULTS: Three overarching themes of the influences on maternal perception of the efficacy of breastfeeding support were identified. These included practical skill and knowledge of the breastfeeding process, the influence of psychological factors on perceived breastfeeding ability, and the provision of a person-centered approach to infant feeding support. CONCLUSIONS: The findings illustrate that the factors associated with supportive breastfeeding practice are extensive, complex, and interrelated. Strategies which enable mothers to gain confidence in their ability to successfully breastfeed by acquiring technical expertise, which offer positive encouragement, and which are culturally specific are more likely to be perceived as supportive by women from socially disadvantaged groups.

Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland.

BACKGROUND: Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record. METHODS: Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically. RESULTS: Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this. CONCLUSIONS: A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes.