(Re)collections: Engaging Feminist Geography with Embodied and Relational Experiences of Pregnancy Losses

With empirically-grounded and theoretically-inferred consideration in this thesis, I bring into focus a vast ‘collection’ of components entailed in lived experiences of pregnancy losses and, in particular, foreground the ways in which spaces and places are intimately involved. This includes, for example, attending to medical settings such as hospitals, workplaces, homes and gardens, online support communities, cemeteries and other memorial locations in addition to bodies which are simultaneously material and emotional. Since pregnancy losses are inter-personal, I also discuss social relations between women, their embryos, foetuses, babies and/or children, medical staff, partners, family members, friends, work colleagues, online group users and ‘wider society’. The multiplicity of components within, and across, participants’ experiences serves to simultaneously break apart and reassemble the label I selected for the research of ‘pregnancy losses’. I utilise several sub-disciplines across the thesis, finding a particularly significant and tricky tension between two particular areas I wish to engage: feminist geographies and the geographies of death and dying. My research weaves together feminist, embodied, emotional geographies through which I seek to understand experiences of pregnancy losses. In doing so, I foreground the richness, depth and complexity of lived experiences by developing understandings of pregnancy losses which embrace, rather than sanitise or marginalise, bodily materiality and social relations as well as emotional dynamics. My thesis serves to bring together and explore the recollections of pregnancy loss experiences, organised around a number of spatial contexts and activities. These are reflected in the focus of each chapter in terms of interior bodies, social relations, bodily fluids, online sites, external skins and practices of memorialisation. My discussions work to ‘collect’ together understandings about the somewhat paradoxical fullness and variety of accumulated meanings that can be held about pregnancy loss experiences

Provision of interpreting support for cross-cultural communication in UK maternity services:A Freedom of Information request

Background: Language, communication and understanding of information are central to safe, ethical and efficient maternity care. The National Health Service (NHS) commissioning board, NHS England, describes how healthcare providers should obtain language support through professionally trained interpreters. Providers of interpreters are commissioned to deliver remote/face to face interpretation across the NHS. Services can be booked in advance or calls can be made in real time. However, women report infrequent use of professionally trained interpreters during their maternity care, often relying on friends and family as interpreters which can compromise confidentiality, disclosure and accuracy.Methods: To determine the demand for, and provision of, professionally trained interpreters in practice, we sent a Freedom of Information (FOI) request to 119 NHS Trusts delivering maternity services in England in November 2022. For the financial years 2020/2021 and 2021/2022, we asked how many women in the maternity service were identified as needing an interpreter, the number and mode of interpreter sessions, and the annual spend on interpreting services. Datawere analysed using descriptive statistics.Results: One hundred maternity Trusts responded by 21st April 2023 (response rate 100/119–84 %). Of these, 56 (56 %) recorded a woman’s need for an interpreter. Nineteen Trusts relied on documentation in paper notes and 37 Trusts recorded the information on a digital system. From the 37 Trusts where this information could be digitally retrieved, women requiring interpretersupport reflected between 1 and 25 % of the annual birth rate of the Trust (average 9 %) and received an average of three interpreter sessions across their pregnancy, birth and postnatal journey. Telephone was the dominant mode used for interpreting sessions, though 11 Trusts favoured face to face interpreting. Financial spend on interpreting services varied across Trusts; some funded their own in-house interpreting services, or worked with local community groups inaddition to their contracted interpreting provider.Conclusion: Information obtained from this FOI request suggests that Documentation of a woman’s interpreting need is not complete or consistent across NHS maternity services. As a result, it is not clear how many women require an interpreter, the mode of provision or how frequently it is provided, and the cost involved. However, the limited information available suggests a failure to provide interpreter support to women at each scheduled care encounter. This raises questions about, the risk of women not understanding the care being offered, and the increased risk of uninformed, unconsented care as women traverse pregnancy and birth

Unsettling experiences: a qualitative inquiry into young peoples' narratives of diagnosis for common skin conditions in the United Kingdom

Skin conditions such as eczema and psoriasis are relatively prevalent health concerns in children, adolescents and young adults. Experiences of these dermatology diagnoses in adolescence have hitherto not been the focus of research, perhaps owing to assumptions that these diagnoses are not particularly impactful or intricate processes, events or labels. We draw on a thematic secondary analysis of in-depth interviews with 42 adolescents and young people living in the United Kingdom and, influenced by the sociologies of diagnosis and time, highlight the psychological, emotional, social and temporal complexities involved in their diagnosis experiences. Firstly, we describe how participants remembered, re- and co-constructed their diagnosis experiences during the interview. Secondly, we explore the pace and rhythm of diagnosis, including mis-diagnoses, highlighting the jarring potential for adolescents on being diagnosed, even for conditions typically deemed minor. Thirdly, we consider the ways in which these diagnoses have the capacity to reformulate notions of past, present and future, including projecting into imagined futures and reinterpreting past bodily sensations. Finally, we examine how memories about and the meaning of diagnosis are revisited, revised and potentially replaced as a child or adolescent grows older, and increases their management of their condition and encounters with healthcare professionals. In unsettling an assumption that diagnosis experiences for adolescents of common skin conditions is unproblematic or straightforward, our qualitative analysis critically engages with and contribute to tenets of health research that are of interest to quantitative and qualitative researchers, clinicians and patients

Unpacking complexity: GP perspectives on addressing the contribution of trauma to women’s ill health

Background: There is an intricate relationship between the mind and the body in experiences of health and wellbeing. This can result in complexity of both symptom presentation and experience. Although the contribution of life trauma to illness experience is well described, this is not always fully recognised or addressed in health care encounters. Negotiating effective and acceptable trauma informed conversations can be difficult for clinicians and patients. Aim: To explore the experience of primary care practitioners caring for women through a trauma informed care lens. Design and Setting: Qualitative study in the general practice setting of England, with reflections from representatives of a group with lived experience of trauma. Methods: A secondary thematic analysis of 46 qualitative interviews conducted online/by telephone to explore primary care practitioner’s experiences of supporting women’s health needs in general practice, alongside consultation with representatives of a lived experience group to contextualise the findings. Results: Four themes were constructed: you prioritise physical symptoms because you don’t want to miss something; you don’t want to alienate people by saying the wrong thing; the system needs to support trauma informed care; delivering trauma informed care takes work which can impact on practitioners. Conclusion: Health Care Practitioners are aware of the difficulties in discussing the interface between trauma and illness with patients, and request support and guidance in how to negotiate this supportively. Lack of support for practitioners moves the focus of trauma informed care from a whole systems approach towards individual clinician – patient interactions

The impact of arthritis on the educational and early work experiences of young people:a qualitative secondary analysis

Introduction: Young people’s transition into adulthood is intertwined with the worlds of education and work. Poor health in adolescence has been associated with poorer education and employment outcomes in adulthood. This paper explores the impact of arthritis on the educational and early work experiences of young people with arthritis. Methods: We undertook a supplementary secondary analysis of a qualitative dataset comprising narrative and semi-structured interviews of 39 young people who had been diagnosed with arthritis in childhood, adolescence or young adulthood. Results: Our findings illustrate how young people living with arthritis are faced with a range of added disruptions and challenges in their educational/vocational lives. There is an important element of resilience associated with the process of making a career choice and acting upon personal aspirations. Appropriate support and flexibility in the workplace/educational setting can enable successful outcomes, but disclosure is not a straightforward process for young people living with arthritis. Conclusions: It is paramount that health providers consistently and effectively address self-advocacy skills with the young person, particularly during educational and vocational transitions. Alongside this, there is the need to further strengthen the health-school/work interface to ensure that young people living with chronic illness can meet their full potential in adulthood

The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

Background The UK's ‘First do no harm’ report highlighted missed opportunities to prevent harm and emphasised the need to incorporate patient voices into healthcare. Due to concerns about, and the subsequent suspension, of vaginal mesh for urinary incontinence thousands of women face the decision about mesh removal surgery. The aim of this study was to explore and understand the experience of living with complications attributed to vaginal mesh surgery so that this knowledge can contribute to improvements in care for those considering mesh, or mesh removal, surgery. Methods This study was embedded in the ‘PURSUE’ study which explored the experiences of 74 people with urogynaecological conditions in the UK (30th April 2021–17th December 2021). Of these 74 people, fifteen women reported complications that they attributed to vaginal mesh surgery. We used the six stages of reflexive thematic analysis to conceptualise these fifteen accounts. Findings Our conceptual model anchors eight themes around two dualities: (1) body parts versus body whole, (2) dominant discourse versus marginal discourse. Our themes indicate that trust can be established through: (1) embodied healthcare that focuses on connecting with patients’ lived experience, (2) dialectic communication that recognises patient experiences and remains open to alternative perspectives. Interpretation This study raises some important issues for education and practice. Our findings can translate to other health settings where treatments aimed to provide care have caused harm. Funding NIHR Policy Research Programme (NIHR202450)

Managing recurrent vulvovaginal thrush from patient and healthcare professional perspectives: a systematic review and thematic synthesis

Objective: This systematic review aims to identify what is known about patient and healthcare professional experiences of managing recurrent vulvovaginal thrush by synthesising published findings. Methods: Five databases were searched for studies on patient and healthcare professional experiences managing recurrent thrush. Two reviewers independently screened and quality assessed qualitative, quantitative, and mixed-methods studies. Findings from eligible studies were thematically synthesised. Results: 720 papers were identified, and 29 were included. Four descriptive themes were developed to depict the repeated management of recurrent thrush. These themes were: (re)experiencing impacts, (re)identifying recurrent thrush, (re)considering consultations, and (re)trying treatments. An analytic high-order frame of ‘interwoven and reoccurring uncertainties’ was used to understand these themes. Conclusions: Patients and healthcare providers face uncertainties when managing recurrent thrush. The inconsistencies raised across papers suggests an unaddressed gap in knowledge about patient experiences and their informational and support needs; this includes insights about this condition’s diagnosis, management, treatment, impacts, and meaning. Practice implications: This review has implications for patient education, health promotion, and communication between patients and providers. Our interpretations suggest the need for more research and resources to help support patients and clinicians in managing this condition to promote more understanding, communication, and collaborative care