Parents' experiences of using videoconferencing as a support in early discharge after childbirth

Objective

to describe parents’ experiences of using videoconferencing (VC) when discharged early from a maternity unit.

Design

a combination of quantitative and qualitative methods was used to describe parents’ experiences. Data were collected via questionnaires and interviews.

Setting

a pilot study involving a maternity department and new parents in their homes was conducted. Through VC, parents discharged early were able to maintain follow-up contact with the midwife via sound and picture at the department.

Participants

nine couples/new parents participated.

Findings

the analysis revealed four categories of responses: ‘feeling confident with the technology’; ‘feeling confident of having control of their privacy’; ‘feeling confident being face-to-face on the VC’; and ‘feeling confident when worries and concerns were met and answers were received’.

Key conclusions

using VC as a support in cases of early discharge after childbirth can facilitate a meeting that makes it possible for new parents to be guided by the midwife in their transition into parenthood.

Implications for practice

the findings of this study indicate that VC equipment may be helpful for parents discharged from hospital early after childbirth. The findings can also be used as a foundation for further development of the application of VC within maternal health care and in health care in rural areas.     

Midwives' experiences of doula support for immigrant women in Sweden--a qualitative study

Objective

to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden.

Design

qualitative study, analysed using content analysis. Data were collected via interviews.

Setting

interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe.

Participants

ten midwives, who participated voluntarily and worked in maternity health care in western Sweden.

Findings

the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support,’ has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’.

Key conclusion and implications for practice

The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women's confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.     

Reclaiming a moral identity: stillbirth, stigma and 'moral mothers'

Objectives

to understand the effect of expectant motherhood discourses on parents who suffer a stillbirth.

Design

a qualitative, exploratory study using in-depth interviews to understand parental experience of stillbirth.

Setting

interviews took place in the homes of bereaved parents across several English health authorities.

Participants

10 couples and 12 mothers who had experienced a stillbirth.

Findings

mothers were keen to distance themselves from behaviour that might be seen as stigmatising, that is, smoking, drinking, etc., while pregnant. Fathers, while keen to stress that their partners had behaved well in pregnancy, made no such claims.

Key conclusions

stillbirth constitutes a threat to a maternal ‘moral’ identity, which results in a differential experience of loss for mothers than for fathers.

Implications for practise

comprehending that the experience of stillbirth might lead the mother to feel that her identity as a ‘moral mother’ is under threat is essential in understanding the maternal experience of stillbirth.     

Fathers' sense of security during the first postnatal week-A qualitative interview study in Sweden

Background

father's sense of security in the early postnatal period is important for the whole family. An instrument, which measures Parents' Postnatal Sense of Security (the PPSS instrument), is under development.

Objective

to explore and describe factors, which influence fathers' sense of security during the first postnatal week.

Methods

an explorative design with a qualitative approach was used. Thirteen fathers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews. Analysis was carried out using qualitative content analysis.

Findings

participation in the processes of pregnancy birth and early parenthood emerged as the main category for fathers' postnatal sense of security. The emergent categories were; ‘willingness to participate and take responsibility’, ‘being given the opportunity to take responsibility’, ‘being assured about mother's and baby's well-being’, ‘having someone to turn to—knowing who to ask’, ‘being met as an individual’ and ‘being met by competent and supporting staff’.

Key conclusions and implications for practice

new and specific items of importance when investigating fathers' sense of security during the early postnatal period have been pinpointed. Fathers' sense of early postnatal security may be enhanced by giving them a genuine opportunity to participate in the whole process and by giving them the opportunity to stay overnight at the hospital after the birth. Midwives and care organisations need to give clear information about where competent help and advice can be obtained at all hours. Midwives should strengthen the fathering role by acknowledging and listening to the father as an individual person.     

The power of language: a secondary analysis of a qualitative study exploring English midwives' support of mother's baby-feeding practice

Objective

to explore the use of language by midwives reporting their experiences of baby-feeding practice.

Design

A qualitative approach incorporating a secondary analysis of data previously collected in a study based on grounded theory principles. Data were collected using in-depth interviews. The secondary analysis involved a content analysis method.

Setting

two maternity services in the north of England.

Participants

30 midwives who worked across all clinical areas.

Findings

these midwives’ explanations of how they supported women with baby feeding suggest that they used language to direct women towards decisions that the midwives thought best, without prior exploration of the woman's understanding and beliefs of baby feeding. Women were often described as ‘girls’ and ‘ladies’ indicating the power differentials in their relationship. The midwives were aware that, at times, the language they used was contradictory to woman-centred maternity care.

Key conclusions

language may be used to control childbearing women and direct them to decisions that the midwife wants, rather than enabling the woman to make her own decisions. The terms used by midwives to relate to women, such as ‘girls’ and ‘ladies’, may be a strategy used to improve a midwife's perception of her status in maternity care.

Implications for practice

language may be used to undermine women. It is important that the language used when interacting with women is considered carefully in order to facilitate an unbiased perspective and to promote partnership. The word ‘women’, rather than ‘girls’ or ‘ladies’, should be used when referring to users of the maternity services.     

'This is just what you do when you are pregnant': a qualitative study of prospective parents in Iceland who accept nuchal translucency screening

Background

nuchal translucency (NT) screening, mainly for Down's syndrome, in the first trimester of pregnancy is becoming an established practice in many countries. However, very little is known about parents’ knowledge and beliefs prior to undergoing screening. Such information is essential to form guidelines regarding informed decision-making.

Objectives

to explore the influences on prospective parents’ decision-making in relation to NT screening in early pregnancy, and to gain insight into how the views of prospective mothers and fathers towards the benefits and implications of screening may differ.

Design

a qualitative study using framework analysis based on a grounded theory approach.

Participants

10 couples, who had decided to have NT screening, were recruited from four community health centres in Iceland. All pregnancies were defined as ‘low risk’ for fetal anomaly.

Data collection

semi-structured interviews were conducted separately with each prospective mother and father at 7–11 weeks and again at 20–24 weeks of gestation. In total, 40 interviews were conducted.

Findings

the majority of prospective mothers in this study had already decided to accept NT screening before they entered the public antenatal care system. The decision to accept screening seemed to lie with the prospective mother and had hardly been discussed by the couple. Differences between prospective mothers and fathers were observed in relation to the expression of expectations towards the benefits of screening and the perception of disability, which is of interest in the context of information provided to prospective parents.

Conclusions and implications

the findings from this study are of interest to clinicians and policy makers forming future guidelines for antenatal care both in Iceland and further afield. It highlights the need for information for prospective parents to be in the public domain prior to their contact with maternity services. Additionally, findings add to knowledge of prospective fathers in early pregnancy regarding how their perceptions of disability may contribute to the couple's decision to accept screening.     

Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden

Background

group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000.

Objective

to investigate parents' experiences of group antenatal care in four different clinics in Sweden.

Method

a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used.

Settings

the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden.

Participants

the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme.

Findings

three themes emerged, ‘The care—combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, ‘The group—a composed recipient of care’, showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, ‘The midwife—a controlling professional’, showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals.

Key conclusions

in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms.

Implications for practise

the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.     

Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth

Objective

to develop a scale to measure maternal satisfaction with birth to evaluate women's experiences in labour and the early postpartum period.

Design

development and psychometric assessment of a multidimensional maternal satisfaction questionnaire.

Setting

maternity unit of a university hospital in Istanbul.

Participants

500 healthy postpartum women.

Methods

five steps were taken in development of the scale: literature review, generating item pool, content validity testing, administration of draft scale and psychometric testing. Two versions of the scale were developed: the Scale for Measuring Maternal Satisfaction–normal birth and the Scale for Measuring Maternal Satisfaction–caesarean birth. Content validity was evaluated by experts. The appropriate draft scale and the Newcastle Satisfaction with Nursing Scale were administered to postpartum women before hospital discharge.

Findings

content validity index scores for the vaginal and caesarean birth scales were 0.91 and 0.89, respectively. Item-total and subscale-total scores correlated significantly for each scale. Evaluation of construct validity through factor analysis yielded 10 subscales: ‘perception of health professionals’, ‘nursing/midwifery care in labour (in caesarean version: preparation for caesarean)’, ‘comforting’, ‘information and involvement in decision making’, ‘meeting baby’, ‘postpartum care’, ‘hospital room’, ‘hospital facilities’, ‘respect for privacy’ and ‘meeting expectations’. Both scales had good internal reliability, with Cronbach's α coefficients of 0.91. The scales established their convergent validity with significant correlations with the Newcastle Satisfaction with Nursing Scale.

Conclusion

the scales are valid and reliable tools for evaluating Turkish women's experiences in labour and the early postpartum period.

Implications for practice

the scales can contribute to the assessment of women's satisfaction with different aspects of care, the quality of care and developments in maternity services.     

Primary maternity care reform: Whose influence is driving the change?

Background

in 2009 the Australian government announced a programme of reform that will change the way maternity services have traditionally been delivered. A shift to a primary maternity care model has occurred despite strong challenges from medicine and a general public that has embraced high technology in all aspects of life including childbirth.

Aim

a critical analysis was undertaken for the purpose of identifying discourses that have influenced the direction of the Australian maternity care reform agenda.

Method

within a critical discourse analysis framework data were collected from state, territory and commonwealth government policy documents, and selected written submissions from national key stakeholder organisations to the National Review of Maternity Services 2008.

Findings

three discourses influencing the direction of the reform are described, these include the following: ‘Australia is one of the safest place to give birth or to be born, but not for everyone’; ‘maternity care is primarily about mothers and babies, not about the service or the health professionals’ and ‘government must ensure provision of safe and sustainable maternity services’.

Conclusion

the Australian government has strong support for the primary maternity care reform backed by a strong key stakeholder alliance involving consumers, midwives and rural doctors. On the contrary to the position of the key stakeholder alliance, the obstetric position has been unable to provide government with solutions to escalating costs and workforce deficits in the delivery of safe and sustainable maternity services. Consumers, rural doctors, midwives and government all agree on the need to safeguard excellent safety and quality standards whilst at the same time reducing high levels of medical intervention and providing options for care in a reformed maternity service designed to meet the needs of all Australian women.     

Childbirth traditions and cultural perceptions of safety in Nepal: Critical spaces to ensure the survival of mothers and newborns in remote mountain villages

Objective

to uncover local beliefs regarding pregnancy and birth in remote mountainous villages of Nepal in order to understand the factors which impact on women's experiences of pregnancy and childbirth and the related interplay of tradition, spiritual beliefs, risk and safety which impact on those experiences.

Design

this study used a qualitative methodological approach with in-depth interviews framework within social constructionist and feminist critical theories.

Setting

the setting comprised two remote Nepalese mountain villages where women have high rates of illiteracy, poverty, disadvantage, maternal and newborn mortality, and low life expectancy. Interviews were conducted between February and June, 2010.

Participants

twenty five pregnant/postnatal women, five husbands, five mothers-in-law, one father-in-law, five service providers and five community stakeholders from the local communities were involved.

Findings

Nepalese women, their families and most of their community strongly value their childbirth traditions and associated spiritual beliefs and they profoundly shape women's views of safety and risk during pregnancy and childbirth, influencing how birth and new motherhood fit into daily life. These intense culturally-based views of childbirth safety and risk conflict starkly with the medical view of childbirth safety and risk.

Key conclusions and implications for practice

if maternity services are to improve maternal and neonatal survival rates in Nepal, maternity care providers must genuinely partner with local women inclusive of their cultural beliefs, and provide locally based primary maternity care. Women will then be more likely to attend maternity care services, and benefit from feeling culturally safe and culturally respected within their spiritual traditions of birth supported by the reduction of risk provided by informed and reverent medicalised care.     

Choice in maternity: rhetoric, reality and resistance

Objective

to inform the organisation of the maternity services in Scotland, a phenomenological study was planned to examine maternity decision making in two similarly small countries. The aim was to examine the experience of contributing to decisions at clinical, organisational and policy-making levels. When examples were needed the informants were asked to use their experience of place of birth decisions.

Design

a hermeneutic phenomenological approach was employed. In-depth, semi-structured conversations were used. The fieldwork extended over a 4-month period in 2005. The data were analysed using Colaizzi's method.

Setting

Finland and New Zealand were chosen because the parallels in their health care and maternity care systems would limit disparities. In one of the Finnish centres, the findings were particularly homogeneous and exemplified many of the issues arising in other settings. The findings of the fieldwork in this Finnish centre are the focus of this paper.

Participants

the informants were mothers, midwife managers/policy makers, midwives and other maternity care providers. The findings of 12 conversations, including mothers and all groups of staff, are reported here.

Findings

the background theme which emerged was ‘trusting the system’. The informants were aware of the extent to which change is happening. One of the sub-themes contrasted the informants’ perceptions of their lack of strength and courage with Finnish stereotypes. Being safe proved to be another crucial issue. The final sub-theme was ‘playing the system’.

Key conclusions

trust in a well-respected health-care system was necessary for the informants to be able to subvert or resist that system. While such resistance has been documented in other disciplines, such as nursing, reference has not been found in relation to maternity. The resistance to the system was, at the time of the fieldwork, neither co-ordinated nor collaborative.

Implications for practice

the findings of this study carry important implications for women's and midwives’ input into maternity care.     

Facts first, then reaction-Expectant fathers' experiences of an ultrasound screening identifying soft markers

Background

expectant fathers often attend pregnancy ultrasound but their needs are poorly examined, especially in connection with adverse findings.

Objective

to explore men's expectations of routine ultrasound and experiences when soft markers were discovered.

Design/setting

a qualitative study at Uppsala University Hospital in Sweden where semi-structured, in-depth interviews were conducted with 17 expectant fathers 6–12 weeks after the discovery of a soft marker at the routine ultrasound scan.

Findings

five major themes emerged: (1) ‘immediate reaction: frustration and thoughts about consequences’, (2) ‘need for facts to gain control’, (3) ‘concern about the partner’, (4) ‘in retrospect: almost okay but routines need changing’ and (5) ‘amniocenteses or not: a joint decision with several considerations’.

Conclusions and implications for practise

these findings contribute important knowledge about men's needs related to pregnancy ultrasound with unexpected findings, and their role in decision-making concerning fetal diagnostics. Our results show that men enter a role of a kind of fact manager and have both a psychological need as well as the capacity to perceive important information during the process following the detection of a soft marker in the fetus. Practitioners conducting pregnancy ultrasound should therefore have relevant knowledge to be able to provide immediate information about soft markers, including risk assessment for chromosomal defects. In addition to this, written information about soft markers should be available to expecting parents in this situation.     

Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health

Objective

to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

Design

a longitudinal regional survey. Data were collected by three questionnaires.

Setting

three hospitals in the middle-north part of Sweden.

Participants

1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

Measurements

childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

Findings

expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2–2.8) and mental (OR 3.0; 1.8–5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4–3.0), and the forthcoming birth (OR 4.3; 2.9–6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

Key conclusions

expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

Implications for practice

this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.     

The experience of repeated fatherhood during adolescence

Objective

to examine how adolescent fathers experience recurring parenthood.

Design

qualitative study with a social phenomenological focus.

Participants

five fathers between 16 and 19 years of age, each with two children.

Findings

the participants perceived themselves as mature, responsible, worried about the care and education of their children, and desiring a secure future life. These factors made them seek employment, their own home, marital stability, construction of a family and return to school. They experienced the ambivalence of desiring one reality and living another, given that, as adolescent parents, they regretted the loss of their freedom.

Key conclusions

recurring parenthood in adolescence is a complex phenomenon, with many possible perceptions. The diverse experiences depend on the social context that is defined by the wishes, plans, possibilities and meanings of each distinct social class.

Implications for practice

care delivery to these adolescents should consider not only theoretical and chronobiological aspects, but also the experiences of these young people and the psychosocial and cultural factors involved in their fatherhood.     

Care during pregnancy and childbirth in Sweden: perspectives of lesbian women

Objective

to explore the views and experiences of care of lesbian women during pregnancy and childbirth.

Design, setting and participants

a qualitative study of 18 lesbian women in southern Sweden.

Findings

valid text units were formed through categorisation into four main categories: recognition of sexual orientation; openness; relationships within the homosexual family; and different encounters and attitudes within the health-care system. The interviewed women were positive about their care during pregnancy and childbirth. However, as in studies regarding women's experiences of care in general, lesbian women raised concerns about postnatal care, parent education and the structure of the patient records with no place for the female partner.

Key conclusions and implications for practice

confirmation of parenthood was important, especially for the co-parent. The participants in this study felt that when they were open about their sexuality, this was met with an openness that they felt was confirming about their homsexuality. It is important for health-care providers not to make assumptions about women's sexuality.     

Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals

Background

four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care.

Objective

to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives.

Design

‘before and after’ study design incorporating two postal surveys of recent mothers (baseline and post-implementation).

Setting

four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational.

Participants

1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001.

Findings

the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change.

Key conclusion

mainstream maternity care can be restructured to improve women's experiences of early postnatal care.

Implications for practice

maternity service providers should consider a multi-faceted approach to reorientating postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice and in the practice of caring; and skill-enhancement opportunities for care providers in managing postnatal issues and in effective communication.     

Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study

Objective

to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain.

Design

an exploratory qualitative research using focus groups and thematic analysis of the discussion.

Setting and participants

three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants.

Findings

the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked.

Key conclusions and implications for practice

empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns.     

Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature

Objective

to present the literature relating to health status and pregnancy complications among sub-Saharan African women.

Background

sub-Saharan refugee women constitute a new and growing group of maternity service users in developed countries today. These women are perceived to be at high risk of pregnancy complication, based on concurrent disease and unusual medical conditions. As a result of these concerns, midwives may feel ill equipped to provide their pregnancy care.

Method

searches were conducted of CINAHL, Maternity and Infant Care, MEDLINE and PsychINFO databases using the search terms ‘migrants’, ‘Africa’, ‘sub-Saharan’, ‘pregnancy’, ‘refugees’ and ‘women’. Additional articles were located by pursuing references identified in key papers.

Findings

pregnant sub-Saharan women present as an at-risk population related to poor prior health, co-existing disease and cultural practices such as female genital mutilation. Nonetheless, principal pregnancy complications for this population include anaemia and high parity, rather than exotic disease. Higher rates of infant mortality and morbidity appear to persist following resettlement, and are not explained by maternal risk factors alone. Limited access to care is of concern.

Key conclusions

further research is warranted into the impediments to care uptake among sub-Saharan African women. It is hoped that such research will inform the development of culturally appropriate and acceptable services for African refugees.

Implications for practice

it is important that midwives are aware of common health problems among sub-Saharan women. Midwives also need to act to promote access to health services among this group. Social disadvantage and late access to care may impact on neonatal outcomes and thus warrant investigation.