The Lived Experience of Perinatal Anxiety: A Longitudinal Interpretative Phenomenological Analysis

Background: Perinatal anxiety has deleterious effects on the fetus, newborn, infant, older child and mother, and is more commonly experienced yet less well investigated than perinatal depression. There is a paucity of qualitative evidence examining lived experience of anxiety over the continuum of pregnancy and the first year post-birth, which limits the ability of healthcare professionals to recognise and fully understand the condition and to provide appropriate care for women and birthing people. Aims: This doctoral study aimed to address the lack of evidence, by exploring how women are impacted by perinatal anxiety to and gaining a rich understanding of their experiences. The findings inform recommendations for clinical practice, research and education. Methods: A qualitative longitudinal design was chosen, using in-depth interviews and Interpretative Phenomenological Analysis to elicit a deeper understanding of perinatal anxiety. Five women were interviewed each at three timepoints: antenatal, early postnatal and late postnatal, producing 15 datasets. Findings: Nine Group Experiential Themes were developed, underpinned by three Longitudinal Experiential Concepts which explicated the common threads of experience over time: Maternal Eyes, Transforming Existence and Emotional Kaleidoscope. The lived experience of perinatal anxiety has been revealed as socially constructed, with aspects of relationships with self, others, and the world key. The collision between anxiety and motherhood as social constructs provides perinatal anxiety with its unique characteristics. Conclusion: Midwives and other healthcare professionals should understand the significance of anxiety as a potentially problematic and destructive psychological experience and provide space for women to discuss stigmatising and uncomfortable feelings without judgement. Further research examining whether screening tools used by midwives, health visitors and GPs identify the less immediately evident characteristics of perinatal anxiety, and effectively flag the need for intervention, is recommended. Education for clinicians to understand the significance of perinatal anxiety is essential

‘Crippling and unfamiliar’: Analysing the concept of perinatal anxiety; definition, recognition and implications for psychological care provision for women during pregnancy and early motherhood

Aim: To clarify how perinatal anxiety is characterised within the current evidence base and discuss how a clearer definition and understanding of this condition may contribute to improving care provision by midwives and other healthcare professionals. Background: Perinatal anxiety is common, occurs more frequently than depression and carries significant morbidity for mother and infant. The concept of perinatal anxiety is ill-defined; this can pose a barrier to understanding, identification and appropriate treatment of the condition. Design: Concept Analysis paper. Method: Rodgers’ Evolutionary Model of Concept Analysis, with review based on PRISMA principles. Findings: While somatic presentation of perinatal anxiety shares characteristics with general anxiety, anxiety is a unique condition within the context of the perinatal period. The precursors to perinatal anxiety are grounded in biopsychosocial factors and the sequelae can be significant for mother, fetus, newborn and older child. Due to the unique nature of perinatal anxiety, questions arise about presentation and diagnosis within the context of adjustment to motherhood, whether services meet women’s needs and how midwives and other health professionals contribute to this. Most current evidence explores screening tools with little examination of the lived experience of perinatal anxiety. Conclusion: Examination of the lived experience of perinatal anxiety is needed to address the gap in evidence and further understand this condition. Service provision should account for the unique nature of the perinatal period and be adapted to meet women’s psychological needs at this time, even in cases of mild or moderate distress

Developing a career and education framework for advanced clinical practice in midwifery

Introduction: This study outlines the nature of Advanced Clinical Practice in Midwifery (ACPiM), reporting on a stakeholder analysis as part of a national project to develop a career framework for advanced practice in midwifery on behalf of the National Health Service (NHS) in England. Methods: Between June and July 2022, 31 advanced practice midwives were recruited across England within the NHS settings. Convenience sampling was used to identify midwives working as advanced practitioners, and those pursuing this career route. Focus group and one-to-one interviews were conducted, recorded, and transcribed. These stakeholder data were then analyzed using a reflexive thematic approach. Results: ACP midwives were active across many professional settings. The findings resulted in three themes: Midwifery autonomy, Desire for progression, and Avenues of support. Midwifery autonomy highlighted a midwifery desire to utilize specialist skills and expert decision-making to provide holistic care directly to women and families. Desire for progression highlighted that, regardless of career stage, midwives aspired to advance their practice requiring a range of pathways to fulfil career satisfaction and meet local population health needs. Avenues of support discussed the barriers and facilitators to progression, highlighting the need for service vision, a multi-disciplinary approach to facilitate support for individuals, and strong midwifery leadership. Conclusions: Although the ACPiM role is desired by maternity institutions and organizations, midwives remain unclear about how to achieve this position, and employers remain unsure of how an ACPiM could transform services. If midwives are to successfully achieve ACPiM status, organizational support is needed to facilitate individuals drive for career progression, resulting in a strengthened workforce and improved patient experience

Future clinical academic midwife and the Midwifery Research Group

Aim of the initiative: To create a professional space and community of support for midwives with an interest in both clinical and academic work. Initiative: Clinical academic career pathways for Nurses, Midwives and Allied Health Professionals (NMAHPs) are a strategic priority for NHS England, and there has been significant investment in the National Institute of Health Research (NIHR) Integrated Clinical Academic (ICA) programme for non-medical healthcare professionals. NMAHPs face numerous barriers to successfully building a clinical academic career. For those outside the NIHR ICA programme, clinical academic career approaches are varied and often driven by individual practitioners rather than robust organisational processes or strategy. The vision of Future Midwife is that midwives maximise opportunities in research and scholarship, however there is little clarity about how these academic aspirations may be supported. Among clinicians, initial interest in research can be sparked by interaction with colleagues involved in research. Role models for aspiring clinical academic midwives are crucial to enable individuals to recognise and understand developmental routes available to them. For student midwives, identifying links between clinical practice and research and encouraging research-focused discussion can enliven the concept of evidence-based practice. Cultural challenges can exist within maternity services where there is little active midwifery research culture and in such an environment, midwives wishing to pursue clinical academic work may struggle to see a path ahead. Finding ways to support aspiring clinical academic midwives to engage in this rewarding and important facet of midwifery practice is key to realising Future Midwife’s scholarly credentials. Process: In early 2021 a scoping exercise took place at the Norfolk and Norwich University Hospital, to establish the appetite among clinical colleagues for a research -related forum. The aim of the forum would be to create a space for midwives with clinical academic interests to learn from one another through sharing research or academic experiences in an informal and relaxed setting. Following confirmation of interest among colleagues, Midwifery Research Group was launched in June 2021. Outcome: MRG is now a well-established clinical academic forum and network, with bi-monthly online meetings which extend across the local maternity and neonatal system and welcome student midwives. Members have positively evaluated their involvement in the group as a unique opportunity to engage in an informal supportive environment to discuss pertinent research and midwifery issues through a clinical academic lens. Conclusion/main learning: Forums such as the Midwifery Research Group are a positive way to support the development of future clinical academic midwives

Future clinical academic midwife

Clinical academic career pathways for nurses, midwives and allied health professionals are a strategic priority for NHS England, and there has been significant investment in the National Institute of Health Research integrated clinical academic programme for non-medical healthcare professionals. Nurses, midwives and allied health professionals face numerous barriers to successfully building a clinical academic career. For those outside the integrated clinical academic programme, clinical academic career approaches are varied and often driven by individual practitioners rather than robust organisational processes or strategy. The vision of ‘future midwife’ is that midwives maximise opportunities in research and scholarship. However, there is little clarity about how these academic aspirations may be supported. This reflective lived experience discussion paper explores key issues around clinical academic midwifery careers, including how space for clinical academic midwives can be assured and the steps midwives can take to start to develop this rewarding and important career

Research in practice: a core skill

Following on from last issue's Birthwrite article, Ruth Sanders and Kelda Folliard discuss teaching research skills to midwifery students through practical technique

Research skills in practice

Kelda Folliard and Ruth Sanders discuss facilitating the conceptual leap for student midwives towards embedding evidence-based practice and research in midwifery

A very, very lonely, unmagical time. The lived experience of perinatal anxiety: A longitudinal interpretative phenomenological analysis

Problem: Minimal longitudinal qualitative evidence examining lived experience of anxiety over the perinatal continuum limits holistic understanding of the course of antenatal and postnatal anxiety. Background: Perinatal anxiety has deleterious effects on the mother and infant and is more commonly experienced yet less well investigated than perinatal depression. Aim and method: To explore women's experiences living with perinatal anxiety to increase understanding of the condition; inform support given by midwives and other health professionals and provide practice, education, and research recommendations. Five women were interviewed at three timepoints, producing 15 datasets. Data was analysed using Longitudinal Interpretative Phenomenological Analysis. Findings: Nine Group Experiential Themes emerged: the anxious mother, transformation, sets of ears and the anxious pregnancy (antenatal); baby as external focus, returning to oneself and the emotional unknown (early postnatal); and moving on, and shifting sands (late postnatal). Three Longitudinal Experiential Concepts explicated lived experience over time: maternal eyes, transforming existence, and emotional kaleidoscope. The lived experience of perinatal anxiety was revealed as socially constructed, with relationships with self, others, and the world key. The collision between anxiety and motherhood as social constructs provides perinatal anxiety with its unique characteristics. Conclusion: Midwives and other healthcare professionals should understand the significance of perinatal anxiety, enabling disclosure of stigmatising and uncomfortable feelings without judgement. Research examining whether perinatal specific screening tools should be used by midwives and exploring the relationship between perinatal anxiety and depression is recommended. Education for clinicians on the significance of perinatal anxiety is essential