Are women empowered to make decisions about the use of antidepressants in pregnancy?

Background: Untreated depression is related to adverse maternal mortality and morbidity. The most frequent treatment option for women is antidepressant medication. Women find decision-making about antidepressant usage in pregnancy difficult and confusing. There is a dearth of information to explain if women are empowered to make decisions around the use of antidepressants in pregnancy. Method: A literature review was conducted using Cinahl Complete, Intermid, Proquest and Discover More. Results: Information provision was inadequate and women experienced decisional conflict. Women wanted to be involved in a collaborative decision-making process. Conclusion: Women want to be provided with clear and accurate information and follow a collaborative decision-making process when making decisions about antidepressants in pregnancy. More research is needed to explore demographic gaps within population samples. Women’s experiences of decision-making about antidepressant usage need to be explored in depth. Undergraduate and postgraduate health education should include conversation skills training, associated with collaborative discussion and informed choice around medication usage

An exploration of the experience of midwifery care by women asylum seekers and refugees

Background: There were approximately 63,097 known asylum seekers in England in 2002 (Heath et aL 2003). Women asylum seekers may be more seriously affected by displacement than men, leading to increased isolation, poverty, hostility and racism (Burnett and Peel, 2001a). In England, Black African including asylum seekers and newly arrived refugees had a seven times greater chance of maternal modality than White women (CEMACH, 2004 p244). Furthermore, women from ethnic groups other than white are twice as likely to die as women in the white group. In the CEMACH report a large number of women who died spoke little English. Access to local information about asylum seekers and refugees was difficult to obtain and suggested a disorganised service provision for this group of women. Aim: It was the intention of this study to explore and synthesise the experience of midwifery care by women asylum seekers and refugees in one large maternity unit in England. Design: Longitudinal exploratory case study research utilising a series of interviews. Sample: Four women from: Afghanistan, Rwanda, Somalia and Zaire. Three women were asylum seekers and one was a refugee. One woman spoke fluent English. Setting: Liverpool Women's Hospital and the women's homes. Years: The study took place from December 2002 - July 2003. Methodology: The research was developed from a constructionist paradigm which identifies that multiple realities can exist for individuals who experience 10 a similar phenomenon. Truth within this perspective is constructed by the individual. The researcher (LB) was the main instrument of data collection. Interpretation was generated via the researcher and was verified by the women at the final interview. The underpinning foundation for this study emerged as symbolic interaction theory (Mead, cited in Morris, 1967 p43; Blumer, 1969). Methods: Following ethical approval consent was obtained with the help of professional interpreters. Exploration was facilitated by in-depth interviews at five time points throughout the antenatal and postnatal period. Photographs taken by the women themselves were used as a prompt for conversation. Analysis: The researcher's interpretation of the data identified emerging themes and categories. The process of analysis involved decontextualisation, display, data complication and re-conceptualisation (Miles and Huberman, 1994 p10). Three key themes were generated: the influence of social policy, understanding in practice and the perception of 'self. Results: Synthesis of the results suggested that social policy directly affected the lives of the women. At times, "taken for granted" communication created a barrier to understanding for the women. Stereotype was socially constructed and pervaded the care environment. The women perceived 'self as a response to social interaction. The midwife-woman relationship relied heavily on gestures and symbols and the women's descriptions are related to symbolic interaction theory. Midwives capable of understanding the subtle cues in communication may be able to negotiate negative stereotypical images generated by society. Women had little or no information around childbirth. Recommendations: Midwifery care would benefit from a deeper understanding of how the women in this study perceived 'self. An advisory post may provide the link between maternity care and broader public health issues. Midwives should engage with asylum seekers and refugees to develop partnerships in care. A collaborative partnership may assist in creating relevant information around childbirth for other asylum seekers and refugees. Innovative methods of dissemination of information related to childbirth should be facilitated by a collaborative approach with non-governmental and community organisations

A mixed methods study to explore women and clinician׳s response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE]

Background: perineal suturing is a common event which affects women across a variety of international settings. Women have expressed pain related to perineal trauma in the postnatal period but little is known about pain during suturing. In addition, there is a lack of evidence to identify how professional decisions are made about pain management during the suturing process. Objective: to explore women and clinician׳s response to pain during the suturing of second degree tears and episiotomies. Design: mixed method feasibility study which included observation, questionnaires and interviews. Setting: a Hospital Trust in Northwest England. Participants: 40 women and 21 clinicians participated. Measurements and findings: mild, moderate and severe pain was measured via the McGill Pain Questionnaire-Short Form (MCPQ-SF). Psychological distress was identified via the Hospital Anxiety and Depression Scale (HADS). Semi-structured face to face interviews identified three themes, Psychological distress and future functioning; Variation in practice and Style of communication. Key conclusions: women who experienced psychological distress during previous or current childbirth scored higher on HADS and MCPQ-SF, and appeared to express more concerns about future functioning and healing. Variation in practice exists and style of communication had the potential to make the difference for women. Implications for practice and research: the process of suturing is complex and is not a standalone event for a woman. It is crucial that health professionals consider previous and subsequent experience of perineal suturing. Future research aims to develop a decision tree to support pain management during suturing

Exploring maternity care for asylum seekers and refugees

The aim of this study was to explore and synthesize the experience of maternity care by female asylum seekers and refugees. The approach was a longitudinal exploratory multiple case study that used a series of interviews, photographs taken by the women, field notes and observational methods to contextualize data obtained during 2002 and 2003. Data was collected in the women's home and a hospital trust. Four women agreed to participate, three women were asylum seekers and one woman was a refugee. Three key themes were generated: the perception of ‘self’ understanding in practice, and the influence of social policy. The women perceived ‘self’ as a response to social interaction. At times, ‘taken for granted’ communication in practice created a barrier to understanding for the women. Social policy related to seeking asylum, dispersement, housing and health directly affecting the lives and subsequent maternity experiences of the women. The theory of symbolic interactionism and transformational educational theory was applied to the findings, highlighting that self-awareness is of paramount importance in care delivery. The strength and resilience of migrating women is acknowledged and should be used as a starting point to develop partnerships in care and to build the woman's self-esteem during their maternity experiences. </jats:p