Qualitative website analysis of information on birth after caesarean section.

BACKGROUND: The United Kingdom (UK) caesarean section (CS) rate is largely determined by reluctance to augment trial of labour and vaginal birth. Choice between repeat CS and attempting vaginal birth after CS (VBAC) in the next pregnancy is challenging, with neither offering clear safety advantages. Women may access online information during the decision-making process. Such information is known to vary in its support for either mode of birth when assessed quantitatively. Therefore, we sought to explore qualitatively, the content and presentation of web-based health care information on birth after caesarean section (CS) in order to identify the dominant messages being conveyed. METHODS: The search engine Google™ was used to conduct an internet search using terms relating to birth after CS. The ten most frequently returned websites meeting relevant purposive sampling criteria were analysed. Sampling criteria were based upon funding source, authorship and intended audience. Images and written textual content together with presence of links to additional media or external web content were analysed using descriptive and thematic analyses respectively. RESULTS: Ten websites were analysed: five funded by Government bodies or professional membership; one via charitable donations, and four funded commercially. All sites compared the advantages and disadvantages of both repeat CS and VBAC. Commercially funded websites favoured a question and answer format alongside images, 'pop-ups', social media forum links and hyperlinks to third-party sites. The relationship between the parent sites and those being linked to may not be readily apparent to users, risking perception of endorsement of either VBAC or repeat CS whether intended or otherwise. Websites affiliated with Government or health services presented referenced clinical information in a factual manner with podcasts of real life experiences. Many imply greater support for VBAC than repeat CS although this was predominantly conveyed through subtle use of words rather than overt messages, with the exception of the latter being apparent in one site. CONCLUSIONS: Websites providing information on birth after CS appear to vary in nature of content according to their funding source. The most user-friendly, balanced and informative websites appear to be those funded by government agencies.

Counselling in the context of fertility and cancer: some sociological insights.

Guidelines issued by a number of bodies highlight the importance of providing information on fertility for young adults receiving a cancer diagnosis. However, previous research has established that provision is uneven and even when information is available, counselling may not be offered. This paper draws on interviews with 15 professionals and 30 younger adults (17-39 years) following a diagnosis of cancer at one tertiary referral centre. Sociological insights highlight the disruption to biographies, plans, identities and personal values involved in acknowledging and responding to the impact of cancer on fertility. Patients and professionals are involved in making difficult decisions in a rapidly evolving situation, in terms of both progression of cancer and advances in treatments for cancer and fertility preservation. It is argued that the constellation of knowledge and skills required does not readily map onto existing professional roles and we suggest that it may be appropriate to provide further training or even to draw on the services of specialist 'oncofertility' counsellors.

Toward developing a training pathway for fertility nurses: report of the 2010 training and educational survey.

Fertility nursing and its role extension has increasingly been referred to as 'specialist' or 'advanced nursing practice'. Nevertheless, Government initiatives have prompted a review of 'Advanced Nursing Practice' and the Nursing & Midwifery Council (NMC) has taken steps to address the disparity of roles, job titles, training and competence of nurse practitioners, concluding that advanced nursing practice should be subject to revalidation in the same way as professional registration. Fertility nurses form an integral part of the multidisciplinary team. Yet no formal or nationally recognised framework or training pathway exists. In this paper, we present the findings of a recent online survey of training and educational needs of fertility nurses; its aim being to work toward developing a national training pathway. Our findings identify the relationship between fertility nurse competencies, advanced nursing practice and medical sub-specialist training, at the same time, highlighting the difference in accessibility, funding and levels of training, as well as assessment and expertise within clinical practice. We conclude that it is essential to protect role extension through regonised Higher Educational Institution (HEI) accreditation, by appropriate, role-focussed training. Notwithstanding a national review, the diverse list of job titles also needs to be addressed adequately to encompass and respect role extension.

Research as a therapeutic experience? An investigation of women's participation in research on ending IVF treatment.

BACKGROUND: Women participate in research for many reasons, some of them therapeutic. This paper retrospectively analyses women's motivations for participating in a study on decision making at the end of in vitro fertilization (IVF) treatment. METHODS: A mixed methods study conducted by a practising midwife had focused on women's experiences of stopping IVF treatment after one or more unsuccessful attempts, and raised awareness of women's motivations for participating. Thematic analysis of interview transcripts permitted issues raised by the participants in the context of 'research as a therapeutic experience' to be explored. RESULTS: Reasons for participating in the study included: (1) altruism; (2) appreciation/gratitude for care received; (3) the need to debrief; and (4) gaining self-awareness and readjustment, which challenged the acceptance of childlessness. Reasons for using the research study as 'a therapeutic experience' in the context of failed IVF may be attributed to: (1) access to direct clinical care and advice; (2) opportunity for self-reflection and rationalization; (3) acceptance of reality; (4) resolution of conflict; and (5) opportunity to unburden themselves. CONCLUSION: Women appeared to use the interview process to reassure themselves about decisions made, and to seek direct clinical advice on whether to continue IVF using donor gametes.

Qualitative research in fertility and reproduction: Does it have any value?

Quantitative researchers may argue that a finding or result is more likely to be accepted as a fact if it is quantified (expressed in numbers), than if it is not (Black, 1994). 'There is little or no scientific evidence, for example to support the well-known "fact" that one couple in 10 is infertile, yet most of us are happy to accept uncritically such simplified, reductionist, and blatantly incorrect statements, so long as they contain at least one number' (Greenhalgh & Taylor, 1997, p. 740). Interest in qualitative methods and their wider exposure in health care has led to necessary scrutiny of this type of research (Mays & Pope, 2000). This article compares the basic purpose and focus of quantitative and qualitative research, and draws attention to the relative lack of qualitative research in fertility and reproduction compared to quantitative methods. The authors highlight the strengths and weaknesses of both methods and promote qualitative methods as a valuable tool in fertility and reproduction related studies.

Ending in-vitro fertilization: women's perception's of decision making.

This study was undertaken to assess patient satisfaction with the decision making process as well as with the decision made at the end of in-vitro fertilization (IVF) treatment. Couples who had decided to end treatment after unsuccessful IVF at a single hospital within the last 24 months were invited to complete a questionnaire. Valid questionnaires were returned by 71 (51%) out of a total of 139 couples. Sixty-nine (97%) questionnaires were completed by the female partner. Most women (73%) felt that they were adequately informed about the issues important to the decision. Fifty-eight women (81%) were involved with the decision making process; 38 (58%) felt supported by the clinic doctor and 41 (62%) were satisfied with the decision made. In response to a number of questions about information provision, few women (18 - 24%, depending on the individual question) felt that they had received enough information from the IVF clinician about advantages and disadvantages of stopping treatment and options such as adoption and fostering. Women contemplating the end of IVF treatment appear to be satisfied with the clinician's attitude, the decision making process and the decision made. While information provided during the final consultation is felt to be adequate for decision making, discussion about certain important options such as adoption and fostering could be more detailed.