Social support within a mother and child group: An ethnographic study situated in the UK

Social support has been associated with positive outcomes regarding the mothering experience, and professional interventions have therefore been developed in formal settings to promote this. An ethnographic approach was used to consider the subjective experiences of mothers attending a professionally‐facilitated group for parents and children aged 0–4 years, focusing on relationships within the group and their importance within existing social networks. Qualitative data were collected from seven participants using interviews and participant observation. These were analyzed by the constant comparison method into codes, categories, and themes. Three themes emerged: past history, being a mother, and function of the group. To ensure mothers and children benefit from such groups, nurses who participate in developing and leading community interventions for mothers and their children need to be aware of the importance of maternal identity and the factors that can impact the relationships between mothers within group settings.     

Place of birth or place of death: An evaluation of 1139 maternal deaths in Nigeria

Objective

to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria.

Design

a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method.

Setting

Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural).

Participants

3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies.

Findings

1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25–34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ²=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital.

Key conclusions

maternal mortality in Nigeria is still unacceptably high.

Implications for practice

ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills.     

A randomized comparison of glycerol-impregnated chromic catgut with untreated chromic catgut for the repair of perineal trauma

Summary. Glycerol-impregnated chromic catgut and untreated chromic catgut were compared in a randomized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery. Medical staff preference was equally divided between the two materials. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum. Women whose perineal trauma was repaired with glycerol-impregnated chromic catgut were 10% more likely to have perineal pain at 10 days and 33% more likely to suffer from dyspareunia in the 3 months following delivery. The high rates of maternal morbidity associated with glycerol-impregnated chromic catgut appear to preclude its use for perineal repair.     

She can lip-read, she''ll be all right: improving maternity care for the deaf and hearing-impaired

In the UK a midwife is unlikely to meet many deaf women during her working life. Therefore very few midwives have a wealth of experience in providing care for these women. Postnatal discussion with one woman showed us that despite our good intentions the care we had given her was inadequate for her individual needs. We recognised that other deaf women were possibly receiving inadequate care. We set out to investigate this, and when we discovered that our suspicions were correct, devised a method that we hoped would improve the care we provided. The process of investigating the needs of deaf women is described in this paper together with the development of a teaching package for student and qualified midwives.     

Women's perceptions of being pregnant and having pregestational diabetes

Objectiveto explore the experiences of White British and South East Asian women with type 1 and type 2 diabetes, and the perceived impact of diabetes on their reproductive health.Designa hermeneutic phenomenological approach was used to explore the perceptions of women with diabetes from two different cultural backgrounds with varied reproductive health experiences. Focus groups and one-to-one interviews were used to elicit women's experiences. An interpretive analytical approach was conducted by two researchers.Settingobstetric and diabetes clinics in three hospital sites in the North West of England.Participantsa purposive sample of 22 women with type 1 or type 2 diabetes of different parity and ethnicity.Findingsthe main themes were relinquishing personal control, pregnancy overshadowed by diabetes and haphazard preconception care.Key conclusionsstrategies should be developed to ensure that whilst safety is maintained, the pregnancy focus is not lost. Women should be supported to optimise their experience as well as clinical outcomes. The convergence of professional roles needs consideration; individual members of multidisciplinary diabetes teams should provide a unique and complementary contribution to care. Preconception care needs to be accessible and responsive to women; this should include recognition of socio-cultural differences.     

Women's expectations and experiences of childbirth

OBJECTIVE: to explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in primiparae. DESIGN: a qualitative study using a phenomenological approach. Data were collected using unstructured, tape-recorded interviews in late pregnancy and at two weeks post birth. SETTING: the north of England. PARTICIPANTS: eight pregnant women, expecting their first baby. FINDINGS: the women all wanted to take an active part in their labour and the feeling of being 'in control' was the main finding and the 'essence' of this study. This was achieved through support from partners, the positive attitudes of the midwives caring for them during pregnancy and labour, information giving during pregnancy and labour and being able to make and be included in decision making during labour. IMPLICATIONS FOR PRACTICE: if women are to be empowered by making choices for childbirth and feeling 'in control', then it is important for midwives to explore and discover the wishes and feelings of women in their care so that realistic expectations can be promoted and then hopefully fulfilled.