Professional issues in maternal mental health scale (PIMMHS): The development and initial validation of a brief and valid measure

Introduction:The life-threatening consequences of perinatal mental health problems (PMHP) are well documented. Midwives are ideally placed to effectively identify women at risk and facilitate early intervention. However, a multitude of factors contribute to failure in recognition and treatment. It would be of value for service providers to be able to identify key professional issues in their own context. The present study sought to develop and evaluate a ‘professional issues in maternal mental health’ scale (PIMMHS), explore its psychometric properties and potential application.Methods:A cross-sectional design and instrument evaluation approach was taken to investigate the psychometric properties of the PIMMHS. A total of 266 student midwives from 10 UK institutions completed the PIMMHS via Survey Monkey.Results:PIMMHS comprises two sub-scales of emotion/communication (PIMMHSEmotion sub-scale) and training (PIMMHS-Training sub-scale). Both PIMMHS subscales demonstrate adequate divergent and convergent validity. Sub-optimal internal consistency was observed for the training sub-scale, however, the PIMMHS-Training had a more impressive effect size in terms of known-groups discriminant validity compared to PIMMHS-Emotion.Conclusions:The PIMMHS appears to be a sound psychometric instrument for assessing professional issues that influence the practice of student midwives in PMH. The PIMMHS could support education providers to identify areas for curriculum development, as well as maternity services in proactive assessment of service provision, to identify training and service development opportunities

Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: findings from a national survey

Background mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate. Objectives to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period. Design this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care. Setting England Participants a random sample of women who had a live birth in January 2014. Measurements the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics. Findings the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects. Conclusions this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems. Implications for practice health care professionals may need additional training to effectively support women with mental health problems during the perinatal period

Women’s experiences of commercial three-dimensional ultrasound scans

Ultrasound has become a routine part of UK maternity care and has a range of diagnostic and screening purposes. The last two decades have seen the development of three-dimensional (3D) scans, which use computer software to produce a seemingly 3D image of the foetus (Rankin et al 1993). Four-dimensional (4D) scans include the dimension of time, i.e. moving images of the foetus. This technology does currently have limited diagnostic use (Campbell 2002, Kurjak et al 2007) though it can be helpful in screening for facial anomalies. Over the last two decades 3D and 4D scans have become available to expectant parents (Roberts 2012) through commercial screening companies. They are generally marketed as ‘bonding scans’ or ‘reassurance scans’ (Wadephul 2013), in line with claims that the more ‘baby-like’ images enhance the parental relationship with the foetus and provide reassurance to expectant parents (Campbell 2002). This is not supported by research into the psychological impact of 3D and 4D scans, which suggests that while these scans may enhance parental recognition of the foetus , they do not increase ‘bonding’ or reassurance compared to conventional two-dimensional (2D) scans (Righetti et al 2005, Rustico et al 2005, Leung et al 2006, Sedgmen et al 2006, Lapaire et al 2007, de Jong-Pleij et al 2013). These studies offered 3D/4D scans as part of their research, rather than exploring women’s experiences of scans they had actively sought out and paid for. The case studies presented in this paper are part of a larger PhD study exploring discourses of 3D/4D scans and women’s experiences of having these scans (Wadephul 2013). The case studies aim to explore why individual women choose commercial 3D/4D scans, what their expectations and experiences are and how the scans affect their psychological experience and their maternal-foetal relationship

The development and initial validation of the Perinatal Mental Health Awareness scale in student midwives

Background & aim: Perinatal mental health problems have been demonstrated to impact upon maternal, and fetal/child outcomes. Despite the global evidence and a policy-driven responsibility for identification of these problems, research demonstrates that student midwives/midwives lack knowledge and confidence to assess, identify, and manage them. A similar context is evident for learning disabilities, despite the holistic care philosophy of midwifery. A brief assessment tool to identify knowledge and confidence defecits and strengths within a holistic care framework could support curriculum development. This study sought to develop a Perinatal Mental Health Awareness scale and evaluate its psychometric properties in student midwives.Methods: We employed a cross-sectional and exploratory instrument development and evaluation design to determine the measurement veracity of the new scale.Results: The scale demonstrated good psychometric properties, revealing three subscales mapping onto (i) mental health symptoms, (ii) physical/medical issues and (iii) learning disability. Results indicated a clear differentiation in scores across the subscales, indicating comparative deficits in mental health domains.Conclusion: Our findings facilitate confidence in the psychometric robustness of the measure. The scale enables student midwives to assess and compare different domains of midwifery practice, in line with a holistic model of midwifery care. A focus on physical health in midwifery education appears to disadvantage knowledge and confidence for managing mental health problems in a midwifery context. This valuable finding highlights the potential need for curriculum rebalancing. The measure offers the opportunity to assess and develop curriculum/training provision and monitor the effectiveness of subsequent curricular developments

What is traumatic birth? A concept analysis and literature review

Background: A number of women experience childbirth as traumatic. This experience can have enduring and potentially lifelong effects on both mental and physical health, and have implications for the woman's relationship with her baby, partner and family. It can also have implications for future decisions about pregnancy and birth. However, the meaning of the term ‘traumatic birth’ remains poorly defined. Clear understanding of the concept is critical to better underpin understanding and effectively evaluate women's experiences. Objective: To review the literature pertaining to ‘traumatic birth’ and produce a definition of the concept. Methods: The concept analysis framework of Walker and Avant (2011) was used. Electronic bibliographic databases CINAHL, Medline, PsycINFO and Cochrane were searched to find papers written in English and dated 1998–2015. From a narrative literature review, the defining attributes were ascertained, and model, borderline, related, contrary, invented and illegitimate cases were constructed. The antecedents and consequences were then identified and empirical referents determined. Findings: The apparent attributes of ‘traumatic birth’ are that a baby has emerged from the body of its mother at a gestation where survival was possible. This birth has involved events and/or care that have caused deep distress or disturbance to the mother, and the distress has outlived the immediate experience. Conclusions: ‘Traumatic birth’ is a complex concept which is used to describe a series of related experiences of, and negative psychological responses to, childbirth. Physical trauma in the form of injury to the baby or mother may be involved, but is not a necessary condition

The impact of antenatal psychological group interventions on psychological well-being : a systematic review of the qualitative and quantitative evidence

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their ‘normality’. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features

A Home-Start peer support scheme for women with low mood following childbirth

Perinatal mental health problems vary in impact and severity, and can have long-lasting effects on maternal health and child psychological health and development. The evidence to support the effectiveness of postnatal peer and volunteer support schemes to improve the long-term health of women is mixed, with some studies highlighting positive effects in terms of reducing symptoms of depression. Using data from a peer support scheme designed to support women with low mood following childbirth, this paper provides insight into the initial support needs of women, alongside the challenges of using volunteer and peer support services. This paper provides health visitors and others working in community settings with an understanding of how volunteer befriending services may, or may not work in community settings. The data suggests that Home-Start does have a positive impact on the lives of some women, however more work is required in order to understand which aspects of the Home-Start intervention women find effective and why

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous

A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems

Aim: To report findings of a systematic review and meta-synthesis of qualitative studies exploring public health nurses’ perceptions and experiences of identifying and managing women with perinatal mental health (PMH) problems. Background: Public health nurses play a key role in supporting women who experience PMH problems and several qualitative studies have explored their role. Design: Systematic review and meta-synthesis. Data sources: A comprehensive search was developed and multiple databases were searched from 2000–2015. Review methods: Studies that employed qualitative methods to explore experiences of public health nurses in identifying and managing women with PMH problems were included. Two reviewers independently assessed the methodological quality of studies. Themes, concepts and interpretations were extracted and synthesized using the process of thematic analysis. Results: Fifteen papers including 14 unique qualitative studies were included. Two overarching themes were identified: ‘conceptualization and detection of PMH problems’ and ‘barriers and facilitators to management’. The former of these comprised several subthemes including the use of formal screening tools vs. clinical intuition and challenges encountered in detection. The latter theme, barriers to management included availability of referral pathways and time. In terms of facilitators, training, public health nursing interventions, support groups and referral pathways were identified as factors that optimize management. Conclusions: Public health nurses use a variety of methods to identify women with PMH problems. However, several support structures are needed to optimize management including access to appropriate referral pathways, support groups and relationship continuity

‘I had a lump in my stomach’: Swedish gay and lesbian students' experiences of their time in school

Objectives: Gay and lesbian youth can experience ignorance and a lack of acknowledgement surrounding their sexual orientation during their time in school. This qualitative interview study describes how Swedish gay and lesbian students experience their secondary school years on the basis that society has heteronormative values. Methods: The data is based on eight telephone interviews with gay and lesbian young adults, aged 18–25 and was analysed using a qualitative narrative approach. Findings: The findings presented four themes: not fitting into the norm of heterosexuality, lacking confirmation of their own homosexuality, finding courage, seeing the school as a supportive or a non-supportive environment. Conclusions: A way to normalise homosexuality can be to discuss sexual development and attraction from a health-promoting perspective. Professionals working in school need to feel comfortable with issues such as sexuality in order to create a situation of confidence for the student