"It's Beyond Water": Stories of Women’s Experience of Using Water for Labour and Birth

This study looks at stories of women’s experience of using water for labour and birth and has explored them to reveal the meaning women make of the experience. Randomised controlled trials report that there are no statistically significant differences in the outcomes for women who use water when compared to those who do not. It has also established that there are no adverse effects on the mother and baby. However, most of the research to date largely ignores what women have to say about the use of water for labour and birth. This study employed an interpretive design using audio-taped conversations with women as the method of data collection, and a thematic analysis of the stories, to identify the meaning women make of their experiences. The research is informed by a feminist perspective, which honours the women’s voices and knowledge. The women's stories reveal that the all-encompassing warmth associated with being enveloped in warm water cradles, supports, relaxes, comforts, soothes, shelters and protects the woman, creates a barrier and offers her a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opens possibilities for women. Women use water to reduce their fear of pain and of childbirth itself. Women use water to cope with pain, not necessarily to remove or diminish pain and to maintain control over the process of birth. It is not necessary to actually give birth in the water to achieve these benefits. Recommendations for midwifery practice include the need for midwives to reflect on their role as guardians of normal birth by examining their personal philosophy of birth, critically examining their outcomes and honouring women's knowledge

Intelligent Structured Intermittent Auscultation (ISIA): A Mixed Methods Evaluation of an Informed Decision-Making Framework for Fetal Heart Rate Monitoring

Intermittent Auscultation (IA) of the fetal heart (FH) is a screening tool for the assessment of fetal well-being during labour; the detection of changes in the FH rate and rhythm may signal fetal compromise. While the evidence reveals that IA is as effective as continuous cardiotocography (CTG) for FH monitoring for low-risk women, current practitioners favour the use of continuous CTG despite the risk of significantly increased maternal and fetal morbidity. Translating the knowledge of the effectiveness of IA into practice became the primary aim of this study. While auscultation and palpation are essential midwifery skills, the teaching of IA does not go beyond simply outlining the protocol for frequency, duration, and timing and less is understood about the underlying physiology associated with what is heard and the reassurance of fetal wellbeing that this provides. A knowledge translation intervention, in the form of an evidence-based informed decision-making framework for Intelligent Structured Intermittent Auscultation (ISIA) and a comprehensive educational intervention were developed to enhance midwives‘ knowledge and awareness of IA and to influence decision-making and practice for FH monitoring for low-risk women. A mixed methods non-experimental pre- and post - intervention study design was used to evaluate the knowledge intervention. Pre measures included a retrospective review of 511 medical records to assess existing FH monitoring practices, and focus groups with 14 midwives explored barriers and facilitators to the use of IA. The intervention was then delivered to a mix of 33 midwives and doctors three months later, followed by a second review of 422 medical records and focus groups with seven midwives to determine any changes in practice and to evaluate outcomes. The findings revealed a statistically significant increase in the use of ISIA with improved documentation, and a relative decrease of 14% in the use an admission CTG for low risk women. The ISIA framework has wide applicability in all maternity settings. This research has illuminated the effects of culture, organisation and the socio-political context on the ability for midwives to utilise their fundamental midwifery skills to promote, facilitate and protect normal physiological birth in the institutional maternity care setting. Engagement with a Knowledge Translation project and the introduction of the ISIA framework for FHR monitoring for low risk women has given midwives voice to generate change

The overuse of intrapartum cardiotocography (CTG) for low-risk women:An actor-network theory analysis of data from focus groups

Background: There is an overuse of cardiotocography for intrapartum fetal monitoring for low-risk women in high-income countries, despite recommendations from evidence-based guidelines. Aim: To understand why midwives use cardiotocography for low-risk women despite evidence-based recommendations and to understand the roles of the cardiotocograph machine. Method: This qualitative study used focus groups for data collection. Thirty-one midwives and three student midwives participated from four different countries: New Zealand, Australia, Denmark, and Norway. Constant comparative analysis, informed by an actor-network theory framework, was the method of data analysis. Findings: Cardiotocography was multifaceted and influenced all attendants in the birth environment. The cardiotocograph itself is assigned different roles within the complex networks surrounding childbirth. The cardiotocograph’s roles were as a babysitter, the midwives’ partner, an agent of shared responsibility, a protector that ‘covers your back’, a disturber of normal birth, and a requested guest. Discussion: The application of the actor-network theory enabled us to understand how midwives perceive cardiotocography. The assigned roles of the cardiotocograph shape its everyday use more than evidence-based guidelines. Discussion of these inconsistencies must inform the use of cardiotocography in the care of women with low-risk pregnancies. Conclusion: We found that the cardiotocograph is a multifaceted actant that influences practice by performing different roles. Drawing on this study, we suggest that actor-network theory could be a helpful theoretical perspective to critically reflect upon the increasing use of technologies within maternity care.publishedVersio

Practice, skills and experience with the Pinard stethoscope for intrapartum Foetal monitoring: Focus group interviews with Norwegian midwives

Objective In most high-income countries, the cardiotocography and handheld Doppler device have replaced the Pinard stethoscope for intrapartum foetal monitoring. As a result, the skills required to use the Pinard are rapidly disappearing from midwifery. The aim of this study was thus to illuminate the knowledge before it is lost, by exploring the practice, skills and experience of Norwegian midwives familiar with the Pinard for intrapartum foetal monitoring. We included midwives who still regularly use the Pinard in their current practice in a variety of birth settings, and those who used the Pinard in the era prior to the introduction of the CTG. Design This study followed a qualitative descriptive design based on mainly focus group interviews, but also including one individual interview. The interviews explored the participants` perspective on their practice, skills and experience regarding the use of the Pinard for intrapartum foetal monitoring. Reflexive thematic analysis captured common patterns across the data, and contextualism was used as research paradigm. Setting and participants In total, 21 midwives with experience using the Pinard for intrapartum foetal monitoring were interviewed. The midwives were either retired and had experience using the Pinard from before the CTG became widespread; worked in an alongside midwifery unit that only oversees low-risk births; or worked in an obstetric unit in a university hospital with an active policy of using the Pinard for intrapartum foetal monitoring. Findings The analysis resulted in four main themes: “Practice and experience with the Pinard are related to context”, “Skills with the Pinard come with work experience”, “The Pinard reveals certain characteristics of foetal sound” and “Midwives` experience with the benefits of using the Pinard”. The midwives considered the context for using the Pinard for intrapartum foetal monitoring relevant. The e availability of technology and applicable situations for using the Pinard influenced how and when they use the Pinard. They further underpinned training and work experience as important for feeling secure when using the Pinard, and this experience made them recognize normal and abnormal foetal sounds. Defining and characterizing these sounds appeared difficult for the midwives, however, and they hesitated and imitated the sound. The midwives felt that the Pinard is beneficial for both the labouring woman and the midwife, as the Pinard's features bring them closer to the labouring woman and help calm the birth suite. They also felt that the Pinard adds further information about the birth and birth process, such as foetal lie, rotation and descent. Keyconclusions Norwegian midwives’ practice, and experiences in using the Pinard for intrapartum foetal monitoring are connected to context as technological development and applicable situations. The midwives explained that knowledge obtained through experience gives them skills to differentiate between normal and abnormal foetal sound characteristics, though they found it difficult to define the characteristics themselves. Using the Pinard stethoscope during birth calms the birth suite and brings the midwife closer to the labouring woman.publishedVersio

Should I stay or should I go? Nursing and midwifery academics intention to stay in or leave academia: A scoping review

Background: There is a chronic lack of appropriately qualified nurses and midwives being attracted into and remaining in the academic workforce. Reasons for this are not well understood but have been linked to stressful work environments related to balancing multiple roles in sometimes unsupportive environments, resulting in overload and demoralisation. Aim: To illuminate factors associated with nursing and midwifery academics\u27 intention to remain in academia and factors associated with intention to leave. Design: A scoping review was undertaken to provide a comprehensive and broad analysis of the related literature. This was guided by Arksey and O\u27Malley. A search strategy was developed using a combination of keywords and subject headings and adapted for four electronic databases to search for papers published between 2013 and 2024. Methods: The review included five steps: (i) identifying the question, (ii) identifying relevant studies, (iii) study selection, (iv) data charting, (v) collating, summarising, and reporting the results. Covidence systematic review software was used. Quality appraisal was undertaken using the Mixed Methods Assessment Tool (MMAT). Results: A total of 2870 papers were identified, 23 were included in the review. Retaining academics includes addressing issues related to promotion positive work environments such teamwork, professional relationships, supporting older academics, and professional development. Preventing attrition includes addressing emotional exhaustion and burnout, and ensuring academics feel valued and are recognised. Notably, there was a lack of research related to the Indigenous nursing and midwifery academic workforce. Conclusion: Given the predicted workforce shortages it is imperative for nursing education providers to develop strategies to promote healthy work environments and career pathways, and identify how to develop strong leadership in an ageing nursing and midwifery academic workforce. Importantly, the lack of research related to the Indigenous academic workforce is concerning and must be a priority area for focus

The Probiotics in Pregnancy Study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy

Quality data for breast milk samples. Description: Details of data recorded for quality control of breast milk samples. (PDF 30 kb

Collaboration for conservation: assessing countrywide carnivore occupancy dynamics from sparse data

Aim: Assessing the distribution and persistence of species across their range is a crucial component of wildlife conservation. It demands data at adequate spatial scales and over extended periods of time, which may only be obtained through collaborative efforts, and the development of methods that integrate heterogeneous datasets. We aimed to combine existing data on large carnivores to evaluate population dynamics and improve knowledge on their distribution nationwide. Location: Botswana. Methods: Between 2010 and 2016, we collated data on African wild dog, cheetah, leopard, brown and spotted hyaena and lion gathered with different survey methods by independent researchers across Botswana. We used a multi-species, multi-method dynamic occupancy model to analyse factors influencing occupancy, persistence and colonization, while accounting for imperfect detection. Lastly, we used the gained knowledge to predict the probability of occurrence of each species countrywide. Results: Wildlife areas and communal rangelands had similar occupancy probabilities for most species. Large carnivore occupancy was low in commercial farming areas and where livestock density was high, except for brown hyaena. Lion occupancy was negatively associated with human density; lion and spotted hyaena occupancy was high where rainfall was high, while the opposite applied to brown hyaena. Lion and leopard occupancy remained constant countrywide over the study period. African wild dog and cheetah occupancy declined over time in the south and north, respectively, whereas both hyaena species expanded their ranges. Countrywide predictions identified the highest occupancy for leopards and lowest for the two hyaena species. Main Conclusions: We highlight the necessity of data sharing and propose a generalizable analytical method that addresses the challenges of heterogeneous data common in ecology. Our approach, which enables a comprehensive multi-species assessment at large spatial and temporal scales, supports the development of data-driven conservation guidelines and the implementation of evidence-based management strategies nationally and internationally

"It's Beyond Water": Stories of Women’s Experience of Using Water for Labour and Birth

This study looks at stories of women’s experience of using water for labour and birth and has explored them to reveal the meaning women make of the experience. Randomised controlled trials report that there are no statistically significant differences in the outcomes for women who use water when compared to those who do not. It has also established that there are no adverse effects on the mother and baby. However, most of the research to date largely ignores what women have to say about the use of water for labour and birth. This study employed an interpretive design using audio-taped conversations with women as the method of data collection, and a thematic analysis of the stories, to identify the meaning women make of their experiences. The research is informed by a feminist perspective, which honours the women’s voices and knowledge. The women's stories reveal that the all-encompassing warmth associated with being enveloped in warm water cradles, supports, relaxes, comforts, soothes, shelters and protects the woman, creates a barrier and offers her a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opens possibilities for women. Women use water to reduce their fear of pain and of childbirth itself. Women use water to cope with pain, not necessarily to remove or diminish pain and to maintain control over the process of birth. It is not necessary to actually give birth in the water to achieve these benefits. Recommendations for midwifery practice include the need for midwives to reflect on their role as guardians of normal birth by examining their personal philosophy of birth, critically examining their outcomes and honouring women's knowledge

Intelligent Structured Intermittent Auscultation (ISIA): A Mixed Methods Evaluation of an Informed Decision-Making Framework for Fetal Heart Rate Monitoring

Intermittent Auscultation (IA) of the fetal heart (FH) is a screening tool for the assessment of fetal well-being during labour; the detection of changes in the FH rate and rhythm may signal fetal compromise. While the evidence reveals that IA is as effective as continuous cardiotocography (CTG) for FH monitoring for low-risk women, current practitioners favour the use of continuous CTG despite the risk of significantly increased maternal and fetal morbidity. Translating the knowledge of the effectiveness of IA into practice became the primary aim of this study. While auscultation and palpation are essential midwifery skills, the teaching of IA does not go beyond simply outlining the protocol for frequency, duration, and timing and less is understood about the underlying physiology associated with what is heard and the reassurance of fetal wellbeing that this provides. A knowledge translation intervention, in the form of an evidence-based informed decision-making framework for Intelligent Structured Intermittent Auscultation (ISIA) and a comprehensive educational intervention were developed to enhance midwives‘ knowledge and awareness of IA and to influence decision-making and practice for FH monitoring for low-risk women. A mixed methods non-experimental pre- and post - intervention study design was used to evaluate the knowledge intervention. Pre measures included a retrospective review of 511 medical records to assess existing FH monitoring practices, and focus groups with 14 midwives explored barriers and facilitators to the use of IA. The intervention was then delivered to a mix of 33 midwives and doctors three months later, followed by a second review of 422 medical records and focus groups with seven midwives to determine any changes in practice and to evaluate outcomes. The findings revealed a statistically significant increase in the use of ISIA with improved documentation, and a relative decrease of 14% in the use an admission CTG for low risk women. The ISIA framework has wide applicability in all maternity settings. This research has illuminated the effects of culture, organisation and the socio-political context on the ability for midwives to utilise their fundamental midwifery skills to promote, facilitate and protect normal physiological birth in the institutional maternity care setting. Engagement with a Knowledge Translation project and the introduction of the ISIA framework for FHR monitoring for low risk women has given midwives voice to generate change