Missing out or singling out? Parents’ views on how health professionals should work with them now to get the best for their child in the future

Aim To investigate parents’ views about how health professionals should identify and work with families who may benefit from additional input to maximise their children’s future health and well-being. Methods A qualitative study was conducted. Eleven focus group interviews were carried out with 54 parents living in the north of England. Comparative analysis was carried out to highlight similarities and differences across key concepts. Results The idea of preventive services was welcomed by all parents. They strongly believed that everyone should have access to services aiming to enhance child well-being. Parents recognised that some families need additional support but were concerned that targeted services could result in missing out on some services. They were also concerned that if certain services were offered because they belonged to a group with an increased likelihood of poor child outcomes this could lead to feelings of being assessed, stereotyped and judged and that their abilities as parents were being questioned. Parents projected a belief in themselves as ‘good parents’ even in adverse circumstances. Targeted services could be acceptable if health professionals introduced them sensitively, for example, encouraging attendance at groups to provide support was considered to be helpful. Conclusions Targeted additional preventive services can be acceptable and welcome if health professionals introduce them sensitively, in the context of an existing relationship, providing parents are active participants

Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England

Background Caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ was a facilitative initiative developed to promote opportunities for normal birth and reduce Caesarean section rates in England. Objective To evaluate the ‘Focus on Normal Birth and Reducing Caesarean section Rates’ programme, by assessment of: impact on Caesarean section rates, use of service improvements tools and participants’ perceptions of factors that sustain or hinder work within participating maternity units. Design A mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants Twenty Hospital Trusts in England (selected from 68 who applied) took part in the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods Collection and analysis of mode of birth data from twenty participating hospital Trusts, web-based questionnaires administered to key individuals in all twenty Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Results There was a marginal decline of 0.5% (25.9% from 26.4%) in mean total Caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July to 31 December 2008). Reduced total Caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower Caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions It is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors

Clinical trials and their tribulations: A midwife's perspective.

From the late 1970's, there was an increasing criticism of hospital maternity care. Conventional practices were challenged, including that of recumbency for birth. ofessionals responded to these criticisms in a variety of ways: more homelike decoration in labour wards, information for women through birth plans and new equipment to use in labour. Some obstetricians utilised the randomised controlled trial to evaluate new methods of management. Inevitably, midwives attending women in labour came into contact with these trials. This thesis utilises the experiences of one such clinical trial. A case study methodology was used to identify the impact of the trial on the work and experiences of midwives attending women in labour. The effects on midwives' work include changes of philosophy, changes to practice, increased work, exacerbation of existing inter-disciplinary tensions and difficulties with communication. The effect of the presence of a midwife research assistant has been explored. Midwives' contact with research at the time of the trial is also included. This programme of research has added to the body of knowledge by demonstrating the extent of the impact of clinical trials on the work and experiences of midwives attending women in labour. The appropriateness of the case study approach for use by midwifery researchers has also been demonstrated. Issues arising from the case study have been further reviewed in the light of contemporary midwifery practice, education and research and related to the wider research agenda. Recommendations are made for the conduct of clinical trials in the labour ward and for future avenues of enquiry

The processes of implementing and sustaining an intensive volunteer one-to-one support (doula) service for disadvantaged pregnant women

'Doulas' (lay women who are trained to support other women during pregnancy, birth and postnatally) can improve outcomes for disadvantaged mothers and babies. This Realist Evaluation study uses qualitative interviews to explore the views of staff, commissioners and local champions about the processes of establishing and sustaining five volunteer doula support projects in England. The six key factors in their successful implementation are: fitting with local commissioning priorities; staff commitment and skills; networking with other agencies; defining and marketing the role; providing strong support for volunteers; and having some costs absorbed by others. The four key factors in sustaining the projects are: finding ways to balance the numbers of referrals and volunteers; shaping the service to local service drivers; constant networking; and creative responses to funding shortages. It is a constant challenge to balance the rate of referrals and the number of trained volunteers within tight budgets and timescales ..

Women’s views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy the optimal methods to identify anxiety in pregnancy have not been confirmed. Methods: A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy. Results: Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support. Conclusions: The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support

Respectful handover: a good alternative when intrapartum continuity of carer cannot be guaranteed

AIM: To explore first-time mothers’ expectations and experiences of being cared for by an unknown midwife and their perceptions around continuity of carer during childbirth. DESIGN: Qualitative Straussian grounded theory methodology. SETTING: Three National Health Service Trusts in England providing maternity care that offered women the possibility of giving birth in different settings (home, freestanding midwifery unit and obstetric unit). PARTICIPANTS: Fourteen first-time mothers in good general health with a straightforward singleton pregnancy anticipating a normal birth. METHODS: Ethical approval was obtained. Data were collected through two semi-structured interviews for each participant (before and after birth). The coding process included the constant comparison between data, literature and analytical memos. FINDINGS: Childbearing women’s expectations during pregnancy and experiences during labour are reported in regard to three main themes: a) encountering an unknown midwife during labour; b) familiarity and immediate connection: ‘I felt like I’ve known her for years’; c) change of shift and respectful handover. CONCLUSION: Respectful and efficient handovers between midwives are crucial in guaranteeing a high level of care when continuity of carer cannot be guaranteed. Midwives should, therefore, pay attention to how the handover is done, how information is conveyed to colleagues taking over care and how this is communicated to the labouring woman and her companions present in the room. A handover should actively involve the mother and the birth partner(s) and be essentially respectful of their needs

'The calm before the storm': A qualitative study of fathers' experiences of early labour

BackgroundEarly labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour.MethodsOpportunity sample offathers (n = 12) in the UK who had been present during their partner’s labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis.ResultsFathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the ‘calm before the storm’ during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt ‘like a spare part’ during the later stages of labour.DiscussionThe study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing ‘nothing’. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value

‘The greatest feeling you get, knowing you have made a big difference’: survey findings on the motivation and experiences of trained volunteer doulas in England

Background Support from a doula is known to have physical and emotional benefits for mothers, but there is little evidence about the experiences of volunteer doulas. This research aimed to understand the motivation and experiences of volunteer doulas who have been trained to support women during pregnancy, birth and the postnatal period. Methods A postal questionnaire survey was sent to volunteer doulas at five volunteer doula projects working in low-income areas in England. Quantitative and qualitative data were analysed in parallel using summary statistics and content analysis respectively. Results Eighty-nine volunteer doulas (response rate 34.5 %) from diverse backgrounds responded to the survey. Major motivators for volunteering included a desire to help others and, to a lesser extent, factors related to future employment. Most reported that the training was effective preparation for their role. They continued volunteering because they derived satisfaction from the doula role, and valued its social aspects. Their confidence, skills, employability and social connectedness had all increased, but many found the ending of the doula-mother relationship challenging. For a minority, negative aspects of their experience included time waiting to be allocated women to support and dissatisfaction with the way the doula service was run. Discussion and conclusions Most respondents found the experience rewarding. To maintain doulas’ motivation as volunteers, services should: ensure doulas can start supporting women as soon as possible after completing the training; consider the merits of more flexible endings to the support relationship; offer opportunities for ongoing mutual support with other doulas, and ensure active support from service staff for volunteers

Establishing information needs and research priorities in response to the Covid-19 pandemic in the local maternity setting

The purpose of this project was to identify gaps in the current evidence base and to identify research priorities in the local context during the Covid-19 pandemic. This paper reports on the application and adaptation of the CHNRI methodology which follows a series of criteria setting, filtering and scoring exercises. The views of maternity care professionals, midwifery managers and leaders, women and families were continually sought throughout the project stages. We found the CHNRI methodology to be a useful framework to highlight topics with greater or smaller consensus within a relatively short time frame and with minimal burden to participants. The criteria were defined to focus on research topics where no existing or on-going studies were identified and topics likely to lead to improvements in care with relevance beyond the Covid-19 pandemic