Educational relationships : a study in midwifery

At its inception in 1902, formal midwifery training developed within hospital midwifery services. With the development of a theoretical base, training became education during the 1980s. During a period of economic and societal changes in the 1990s, midwifery education was incorporated into higher education, separating education from health service practice. There were consequences for midwifery education especially the structure of pedagogical relationships.\ud This thesis looks at key sets of relationships in midwifery education between the three main groups of actors: academics, clinicians and students. In so doing, the inquiry utilises a grounded theory approach and embraces disciplines of education, social sciences, social psychology, management and philosophy. The study confirms the importance of relationships between the key actors as part of a student's learning experiences. However, these relationships have become more problematic as a result of the organisational separation between the academic and professional components. \ud A framework is proposed to describe educational relationships in midwifery. The framework has six dimensions; (i) a core component of personal traits, (ii) a secondary component of social and communication abilities and four subsidiary components of (iii) professional expertise, (iv) personal knowledge, (v) education knowledge and skills and (vi) a vision for practice. Realisation of the components by one person of another within the three groups aids mutuality in understanding. General principles are offered that include notions of encounter, exchange, rules, boundaries, reciprocity and reinforcement that aid in constructions of relationships.\ud Though these conditions, in themselves, aid the formation of learning relationships, two processes occur in these relationships through encounters, that is, complementation (a unity of meanings between actors) and complementarity (a matching of understandings). These require a forum for encounters. A model of education is proposed that offers just such a forum aiding positive encounters to promote learning between the three groups of actors. Features of this model are the development of teachers within clinical practice, accreditation of practitioners as educators and the education of students primarily in clinical situations with interactive learning. \u

A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress. Objectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sections 2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience. Inclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention. Search strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material. Methodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute. Data extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken. Results: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found. Definitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning. Conclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence. Implications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice. Implications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered. More research is needed on the effectiveness of group interventions and the role of midwives in administering interventions. A standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made. Outcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion

Young mothers' decisions to initiate and continue breastfeeding in the UK: tensions inherent in the paradox between being but not being able to be seen to be a good mother

Background. In the UK and other developed nations, adolescent mothers are among those least likely to breastfeed, yet they and their children would potentially benefit more from breastfeeding than advantaged groups. Aim. To explore the ways in which a small group of UK adolescent mothers conceptualise their decisions to breastfeed and experience breastfeeding in their communities. Method. A total of six focus groups or interviews with 15 mothers aged 16 to 20. Participants were recruited at young parent groups in Oxfordshire, England. Ethical approval was obtained from the relevant NHS and university authorities. Findings. Young UK women are acutely aware of the stigma attached to young motherhood in the UK and consider that breastfeeding can help overcome this through its associations with good mothering. Although some did not initially want to breastfeed, they developed a desire to do so as their pregnancy progressed. In common with older breastfeeding mothers, young mothers in the UK rarely feel able to breastfeed in public or in front of male family members. This creates conflict and distress for young mothers, who, as new adults, need to be judged positively, and accepted by and integrated into their families and communities. Young mothers identified a paucity of support for breastfeeding within their social networks, and found maintaining exclusive breastfeeding difficult. Implications. The paradox between being, but not being able to be seen to be, a good mother creates problems and exacerbates existing tensions between young women and their families and communities. An understanding of the conceptual framework used by young mothers in the UK who decide to breastfeed, and of the difficulties they face, may enable midwives to provide appropriate, targeted advice and support for this group