Childbirth as sacred celebration.

This chapter explores how childbirth is spiritually experienced and meaningful within society revealing how childbirth has purpose both individually and collectively. The discourse and mood around childbirth internationally is often concerned with risk, morbidity and mortality yet philosophers O'Byrne (2010) and Arendt (1958) infer that childbirth is a celebration of natality and future possibility, not purely avoidance of mortality. This chapter acknowledges birth as both joy and sorrow, birth as the potential for epiphany, peak experience, moments of self-actualisation and a time of remembrance. The notions of Kairos time (sacred felt-time) at birth and meaningful encounters in and around childbirth is introduced with narrative examples. Something lies quiescent in the background of childbirth gesturing to ineffability, the inexplicable, and what is mysterious and awe inspiring

Providing rural and remote rural midwifery care: an 'expensive hobby'.

Background: Providing midwifery care in rural and remote rural regions can be challenging in many ways. This includes financial arrangements for midwives in New Zealand. This paper draws from a larger study exploring the lived experience of rural and remote rural families, midwives, general practitioners (GPs) and ambulance crews. Aim: The focus of this paper is on the financial lived experiences of the rural midwife participants in this study. Method: A qualitative study using hermeneutic phenomenology was used to explore the experiences of six rural midwives. Participants were from two regions in the South Island and two regions in the North Island and interviewed following ethical approval. Interviews were interpretively analysed. Findings: Several tensions surfaced in the study. Across these tensions it was evident that the current funding for rural and remote rural midwifery is not working well. The participants revealed the challenges and financial hardships which they as rural midwives experience in maintaining a local midwifery service and how these challenges adversely affect their wellbeing and safety. The themes, 'cost of distance?, 'spirit of generosity exploited?, 'being treated unfairly' and 'working rurally can be an expensive hobby', are uncovered through stories of rural and remote rural midwives. Conclusion: The current financial system does not serve these midwifery practitioners working in rural and remote areas. Without more financial support reflecting local needs, midwifery services in some of these rural regions are not sustainable and recruitment and retention will continue to be a challenge. There are Lead Maternity Carer (LMC) midwives working in rural, and in particular, remote rural regions who are concerned about the inequality and unfairness of remuneration. This may result in increasing the vulnerability of the maternity service for these regions. Rural and remote rural midwives' need for improved financial support is urgent and requires immediate attention at national level

Resilience and sustainability amongst maternity care providers.

This chapter looks at maternity care providers who provide care in this social, political and emotional milieu on a daily basis. The emotional work of maternity care provision cannot be underestimated. Contemporary maternity environments have an accumulative psychosocial and biomedical complexity and acuity which place increasing stresses for perinatal health providers when supporting women. This is coupled with the growing desire for technological interventions from mothers and families who use the services. With raising birth rates juxtaposed to financially stretched local services and frequent unrealistic staffing ratios in many services, the potential for unhealthy practices and low levels of resilience in order 'to cope' arise in practice reality. There is evidence of increasing burnout, emotional fatigue, depression and subsequent reduction in work satisfaction in perinatal health workforce. Turning our attention to the psychosocial wellbeing of perinatal health workforce is relevant.1

Birth and spirituality.

Spirituality and healthcare is predominantly focussed on end of life care, the central concern of this chapter is spirituality at the start of life. Although there is emergent literature gesturing towards spirituality and healthcare there remains a paucity of literature that solely focusses on spirituality at the beginning of life and reproduction. A systematic review of the literature using a hermeneutic (interpretive) lens found that what literature there is focussed on spiritual ‘care’, - the act of doing, whilst the lived-experience of spirituality at birth was often left as a cliché after thought, for example, ‘it was so joyful when the baby arrived’, and ‘it is such a lovely special moment’. Yet despite this paucity of published evidence birth is fundamentally experiential and involves and concerns us all: parents, those planning to be parents, people that do not have or plan to have children and health care professionals involved in maternity (e.g. medical staff, midwives and other allied health care professionals)

Migrant Polish women overcoming communication challenges in Scottish maternity services: a qualitative descriptive study.

Background: Migrant women are more likely to experience sub-optimal maternity outcomes and are often described in a problematised way. Communication is crucial in maternity and can be compromised if the language of that service is delivered in a language incomprehensible to migrant women. Methods: Qualitative descriptive study using 9 in-depth individual interviews with Polish women who recently had experience of local maternity services. Recorded interviews were transcribed and thematically analysed. A salutogenic conceptual framework was adopted for data analysis. Findings: Three descriptive themes: ‘Communication and understanding’, ‘Relationships matter’ and Values and expectations’. Seven related subthemes where identified. Discussion: Vulnerability in this study is understood as uncertainty, risk and emotional exposure to situations that are not understandable. Applying a salutogenic lens to analysis reveals the significance of quality communication, relationship and culturally sensitive practices as ways of mitigating feelings of vulnerability in the host country. Antonovski’s Sense of Coherence’ (SoC) highlights migrant women’s ability to comprehend and capacity to understand their unique experiences of communication challenges. Participant’s psychosocial, cultural, and individual beliefs reveal an ability to trust maternity systems that are different from their own cultural values and help them move towards a Sense of Coherence (SOC) and face their vulnerability. Conclusion: Working with migrant women requires a salutary focus. Maternity care professionals involved in the care of this population need to consider individual internal and external resources and avoid treating migrant women as a problematic group. Maternity care provision needs to acknowledge migrant women’s strengths, values and expectations and adapt local services. This is done by addressing individual woman’s needs through a salutary focus, person-centredness and a system of care that values relationships and social connectedness

Service evaluation of relaxation workshops for pregnant women.

This article reports a service evaluation of 'antenatal education on physiology of childbirth and relaxation'. A service evaluation was carried out during group class discussion, immediately after the workshops, and following birth. Identified themes in the collected data were (a) my own relaxation, (b) confident, and not afraid, (c) proud of myself, (d) unexpected and feeling in control, and (e) support. Overall, women creatively customized the learned skills and reported feelings of pride and confidence. They reported feeling able to apply relaxation techniques when unexpected situations arise. Support and encouragement from partners and midwives were also valued by women. The evaluation demonstrates the efficacy of designing antenatal education that includes education on physiology of normal birth and relaxation training

An existential and spiritual discussion about childbirth: contrasting spirituality at the beginning and end of life.

Birth and death are both fundamental human experiences. The end of life has been a major topic in philosophical, psychological, and sociological debates. Meanwhile, the beginning of life seems to be ignored in discussions around existential meanings and spirituality. Recently a growing number of empirical studies are emerging that focus more on birth as lived experience, revealing existential and spiritual issues around childbirth. In this article, we bring together insights from different discipline perspectives, such as philosophy, spirituality studies, and midwifery, to open the dialogue for studying meaning making and spirituality at the start of life. In order to bring these insights into relief, end-of-life literature is used as a comparative perspective. This existential and spiritual analysis on start of life reveals the need to focus more on an embodied and relational spirituality in and around birth. In this age of fast paced technological and medical innovation, research from multiple perspectives needs to be done to explore existential and spiritual understandings at the start of life

Health policy and its unintended consequences for midwife-woman partnerships: is normal pregnancy at risk when the BMI measure is used?

Background: Little attention has been paid to understanding the unintended consequences of health policy for midwife-woman partnerships. The measure of Body Mass Index (BMI) is one such policy example which has become established in contemporary midwifery practice as a tool for assessing pregnancy risk. The universal acceptance of BMI creates an unsettling paradox for midwives concerned with promoting woman-centred practice. The increasing focus on BMI is challenging for midwives as they navigate ethical tensions when directed to undertake practices which have potential unwonted consequences for the midwife-woman partnership. Aim: The aim of the study was to explore the use of an indicator, using BMI as an example, to provide an international perspective on obesity prevention policy and maternity care provision. Method: A comparative case study approach was taken, using descriptive cross-national comparative analysis of obesity prevention policy, weight management guidelines and midwifery models of care in New Zealand and Scotland. Discussion: Despite promoting healthy weight gain in pregnancy, New Zealand and Scottish health policies may be missing health promotion opportunities. Focusing on BMI in maternity, per se, should not prohibit other assessment of lifestyle issues or delivery of services based on individual needs, capacities, histories and sociological characteristics. Relying solely on pre-pregnancy BMI as a marker of health in all women has remained relatively unchallenged and, as such, constitutes a policy problem because it occludes the factoring in of other lifestyle issues that may significantly alter individual risk status. Further, such an assessment of risk status is ideally arrived at within a partnership model of maternity care, rather than reliance on an a priori medical test. Conclusion: Decontextualised policies are challenging for midwives where medical and midwifery values are in conflict. Policy which fails to consider the multiple and complex contexts of women's lives is confronting for midwives as they attempt to re-articulate the meaning of woman-centred practice. Furthermore, BMI as a tool may be ineffectual. The current focus on BMI in policy and practice requires re-consideration

Unsettling moods in rural midwifery practice.

Background: Rural midwifery and maternity care is vulnerable due to geographical isolation, staffing recruitment and retention. Highlighting the concerns within rural midwifery is important for safe sustainable service delivery. Method: Hermeneutic phenomenological study undertaken in New Zealand (NZ). 13 participants were recruited in rural regions through snowball technique and interviewed. Transcribed interview data was interpretively analysed. Findings are discussed through the use of philosophical notions and related published literature. Findings: Unsettling mood of anxiety was revealed in two themes (a) 'Moments of rural practice' as panicky moments; an emergency moment; the unexpected moment and (b) 'Feelings of being judged' as fearing criticism; fear of the unexpected happening to 'me' fear of losing my reputation; fear of feeling blamed; fear of being identified. Conclusions: Although the reality of rural maternity can be more challenging due to geographic location than urban areas this need not be a reason to further isolate these communities through negative judgement and decontextualized policy. Fear of what was happening now and something possibly happening in the future were part of the midwives' reality. The joy and delight of working rurally can become overshadowed by a tide of unsettling and disempowering fears. Implications: Positive images of rural midwifery need dissemination. It is essential that rural midwives and their communities are heard at all levels if their vulnerability is to be lessened and sustainable safe rural communities strengthened