Spirituality and childbirth: An international virtual co-operative inquiry.

PROBLEM: Medicalised maternity systems do not address spirituality as an aspect of childbirth and its practices of care. Neglecting the spiritual nature of childbirth may negatively affect psychological, emotional and physical wellbeing. BACKGROUND: While there is growing interest in the spiritual side of childbirth there is a paucity of literature on the topic, and hence a lack of understanding generally about how to attend to women's needs for emotional and spiritual support in childbirth. AIM: To collaboratively and through consensus explore ways that spirituality could be honoured in 2st Century maternity care. METHODS: An online co-operative inquiry. Starting with a scoping exercise (N=17) nine co-inquirers continued to Phase One using online discussion boards and seven co-inquirers continued to Phase Two and Three. Co-inquirers were involved in international group work and individual reflective and transformational processes throughout. FINDINGS: Four reflective themes emerged: 'meaning and sense-making'; 'birth culture'; 'embodied relationships and intuition'; and 'space/place/time'. 'Spiritual midwifing' was an overarching theme. There were eight areas of individual transformation and actions concerning spirituality and birth: 1) disseminating inquiry findings; 2) motivating conversations and new ways of thinking; 3) remembering interconnectedness across time and spaces; 4) transforming relationships; 5) transforming practice; 6) generating reflexivity; 7) inspiring self and others to change, and 8) inspiring creativity. CONCLUSION: Spiritual awareness around birth experience emerges through relationships and is affected by the spatial environment. Spiritual midwifing is a relational approach to birth care that recognises and honours the existential significance and meaningfulness of childbirth.

Women's lived experience of compassionate midwifery: Human and professional.

OBJECTIVE: To develop an understanding of women's lived experience of compassionate midwifery DESIGN: A qualitative study using the principles of Interpretive Phenomenological Analysis (IPA). Data was collected during interviews with 17 women who identified themselves as having received compassionate midwifery care. FINDINGS: Women participants' experience of compassionate care from midwives was experienced through a sense of a midwife Being With them, Being in Relationship with them and Empowerment. Women were also aware of the way midwives were able to Balance potentially conflicting aspects of their work, in order to provide compassionate care. Two other themes which emerged through extensive analysis of the data related to how women set their experience of compassion in the context of their personal suffering and that compassion made a difference. These themes will be reported separately. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The unique contribution of this study was to provide a window into the nature of women's lived experiences of compassionate midwifery and thus building, understanding around the qualities of compassionate midwifery and its impact on women. The findings are important because they challenge assumptions that compassion is ill-defined and therefore difficult to teach. On the contrary, compassionate midwifery was easily identified by women participants and had the features of an effective intervention for relieving their suffering. A dynamic model of Compassionate Midwifery in Balance has been proposed, providing a much-needed tool to inform practice, education and policy. Further research will build on this work by focussing on women in varied circumstances, environments and cultures and on understanding the lived experience of compassionate midwifery from the midwife's perspective.

A concept analysis of compassionate midwifery.

AIM: To report a concept analysis of compassionate midwifery. BACKGROUND: Recently, compassion has been incorporated into United Kingdom nursing and midwifery language through strategy, policy, recruitment and education. Professional standards direct midwives to practise compassionately therefore the concept of compassionate midwifery exists, although this has yet to be explored as a concept in the UK or internationally. An understanding of what constitutes compassionate midwifery has the potential to increase midwifery knowledge and improve practice. DESIGN: Concept Analysis. DATA SOURCES: Literature from 1990-2015 was searched using MEDLINE, CINAHL, PsycINFO and ETHOS. Grey literature and examples of everyday usage of the concept were searched using Google. METHODS: An adapted model of evolutionary concept analysis. RESULTS: Explanations of compassionate midwifery were absent in the literature therefore the gathered data were evaluated in relation to elements of the compassion process: recognition of suffering, emotion, motivation and action. Compassionate midwifery is defined as the interrelations of authentic presence, noticing suffering, empathy, connectedness/relationship, emotion work, motivation to help/support, empowering women and alleviating suffering through negotiation, knowledge and skills. Antecedents and consequences were also identified and depicted in a schematic representation of the concept. CONCLUSION: This concept analysis provides a unique examination of compassionate midwifery and starting point for reflection on practice, education and further analysis. Empirical studies will provide the potential to take the process further by studying the experience of compassionate midwifery from different perspectives. A theory of compassionate midwifery will develop as new findings emerge.

Midwives' experiences of referring obese women to either a community or home-based antenatal weight management service: Implications for service providers and midwifery practice.

OBJECTIVE: a variety of services to support women to undertake weight management behaviours during pregnancy have recently been implemented as a means to reduce the risks to mother and infant. In the UK, midwives lead the care of the majority of pregnant women and are seen as the ideal source of referral into antenatal services. However, midwives have reported concerns regarding raising the topic of weight with obese women and negative referral experiences have been cited as a reason not to engage with a service. This study explored midwives' experiences of referring women to one of two antenatal weight management services. DESIGN: qualitative, cross-sectional interview and focus group study, with data analysed thematically. SETTING: midwifery teams in the West Midlands, England. PARTICIPANTS: midwives responsible for referring to either a home-based, one to one service (N=12), or a community-based, group service (N=11). FINDINGS: four themes emerged from the data. Participants generally had a positive View of the service, but their Information needs were not fully met, as they wanted more detail about the service and feedback regarding the women they had referred. Approaches to referral differed, with some participants referring all women who met the eligibility criteria, and some offering women a choice to be referred or not. Occasionally the topic was not raised at all when a negative reception was anticipated. Reasons for poor uptake of the services included pragmatic barriers, and their perception of women's lack of interest in weight management. KEY CONCLUSIONS: midwives' differing views on choice and gaining agreement to refer means referral practices vary, which could increase the risk that obese women have inequitable access to weight management services. However, midwives' confidence in the services on offer may be increased with more detailed information about the service and feedback on referrals, which would additionally act as prompts to refer. IMPLICATIONS FOR PRACTICE: weight management services need to improve communication with their referral agents and try to overcome practical and psychosocial barriers to uptake. It would be beneficial to develop a shared understanding of the concept of 'informed choice' specifically regarding referral to health promotion services among midwives. Training which demonstrates effective methods of sensitively introducing a weight management service to obese women may increase midwives' confidence to consistently include this in their practice. These measures may improve women's engagement with services which have the potential to reduce the risks associated with maternal obesity.

Connecting for compassion.

On a mission to promote compassion in midwifery practice I was looking for effective methods of sharing and developing my ideas. I recognised the benefits of networking through more traditional methods but was not really utilising social media. Then another midwife encouraged me to use Twitter. Although not particularly confident with social media and unsure about how it could support me professionally, I decided to try it. Six months later I have some new skills and I am part of a dynamic and stimulating online community. This article is a personal account of that learning journey in which I reflect on some of the benefits that I have discovered so far.